Frovatriptan

How it works

It is a selective serotonin 5-HT1B/1D receptor agonist that causes cranial vasoconstriction and inhibits release of pro-inflammatory neuropeptides in the trigeminovascular system.

Prescribing in practice

• It is contraindicated in ischaemic heart disease, coronary vasospasm, uncontrolled hypertension and cerebrovascular disease because of its vasoconstrictor action.
• It should not be combined with ergot alkaloids or used close to other triptans, and overuse can cause medication-overuse headache.
• It treats the acute attack and has no role in migraine prophylaxis; assess cardiovascular risk before first use.

Monitoring

No routine laboratory monitoring is required, but cardiovascular risk should be assessed before starting and the frequency of use reviewed to detect medication-overuse headache.

Counselling the patient

• Take it as soon as the migraine headache starts rather than at the aura stage.
• Do not use it on too many days each month, as frequent use can cause more headaches.
• Seek advice if you get chest tightness, pressure or pain after taking it.

Evidence & guidelines

Frovatriptan is an effective acute migraine therapy; its relatively long half-life among the triptans has prompted study in menstrual migraine.