Hair analysis for detection of triptans occasionally used or overused by migraine patients-a pilot study.
PURPOSE
The aim of this study is to evaluate the detection rate of almotriptan, eletriptan, frovatriptan, sumatriptan, rizatriptan, and zolmitriptan in the hair of migraineurs taking these drugs; the degree of agreement between type of self-reported triptan and triptan found in hair; if the concentrations in hair were related to the reported cumulative doses of triptans; and whether hair analysis was able to distinguish occasional use from the overuse of these drugs.


METHODS
Out of 300 headache patients consecutively enrolled, we included 147 migraine patients who reported to have taken at least one dose of one triptan in the previous 3 months; 51 % of the patients overused triptans. A detailed pharmacological history and a sample of hair were collected for each patient. Hair samples were analyzed by liquid chromatography-electrospray tandem mass spectrometry (LC-MS/MS) by a method that we developed.


RESULTS
All the triptans could be detected in the hair of the patients. The agreement between type of self-reported triptan and type of triptan found in hair was from fair to good for frovatriptan and zolmitriptan and excellent for almotriptan, eletriptan, sumatriptan, and rizatriptan (P < 0.01, Cohen's kappa). The correlation between the reported quantities of triptan and hair concentrations was statistically significant for almotriptan, eletriptan, rizatriptan, and sumatriptan (P < 0.01, Spearman's rank correlation coefficient). The accuracy of hair analysis in distinguishing occasionally users from overusers was high for almotriptan (ROC AUC = 0.9092), eletriptan (ROC AUC = 0.8721), rizatriptan (ROC AUC = 0.9724), and sumatriptan (ROC AUC = 0.9583).


CONCLUSIONS
Hair analysis can be a valuable system to discriminate occasional use from triptan overuse.
['Ferrari|Anna|A|', 'Baraldi|Carlo|C|', 'Licata|Manuela|M|', 'Vandelli|Daniele|D|', 'Marchesi|Filippo|F|', 'Palazzoli|Federica|F|', 'Verri|Patrizia|P|', 'Rustichelli|Cecilia|C|', 'Giuliani|Enrico|E|', 'Silingardi|Enrico|E|']
D000328:Adult D005260:Female D006197:Hair D006801:Humans D008297:Male D008875:Middle Aged D008881:Migraine Disorders D010865:Pilot Projects D000067490:Prescription Drug Overuse D014363:Tryptamines
Hair analysis Triptan Migraine Medication-overuse headache Monitoring ROC curve