Expert opinion: assessing cardiac risk prior to use of triptans.

CLINICAL HISTORY This 60-year-old woman has had a history of severe migraines without aura since she was 25 years old. The attacks now occur once every 3 weeks or less, lasting up to a week without treatment. Sumatriptan, 6 mg, administered subcutaneously (SQ) completely relieves the headache and zolmitriptan, 5 mg, decreases the headaches to a dull level. Sumatriptan, 50 mg, administered orally, a sumatriptan 20-mg nasal spray, and rizatriptan, 10 mg, do not help. There is no history of hypertension, diabetes, ischemic heart disease, cerebrovascular disease, or hyperlipidemia. Questions.— Can the use of sumatriptan SQ or zolmitriptan be safely continued into the patient’s 60s? Should she have some type of cardiac screening, and if so, what? If she were male or had one or more cardiac risk factors, would your recommendations be the same?