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Patients who do not respond adequately to triptans have limited acute-treatment options, particularly when poor response is due to efficacy rather than intolerance. The CENTURION study included a prespecified analysis of patients with insufficient triptan response and evaluated lasmiditan over repeated attacks. Lasmiditan 100 mg and 200 mg were superior to placebo for early pain freedom, pain relief, freedom from the most bothersome symptom and reduced need for rescue medication. The analysis also found consistency of effect across multiple attacks, suggesting that benefit was not confined to an isolated successful episode. The study is relevant to clinical practice because it addresses a common real-world problem rather than treatment-naive migraine. For HCPs, the findings support considering lasmiditan when prior triptans have not delivered adequate relief, while recognising the drug's CNS adverse effects. Patients should be counselled about dizziness, somnolence and activity restrictions after dosing. The broader message is that failure of one acute migraine mechanism does not mean all future acute therapies will fail; alternative pathways can still provide meaningful benefit.
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Patients who do not respond adequately to triptans have limited acute-treatment options, particularly when poor response is due to efficacy rather than intolerance. The CENTURION study included a prespecified analysis of patients with insufficient triptan response and evaluated lasmiditan over repeated attacks. Lasmiditan 100 mg and 200 mg were superior to placebo for early pain freedom, pain relief, freedom from the most bothersome symptom and reduced need for rescue medication. The analysis also found consistency of effect across multiple attacks, suggesting that benefit was not confined to an isolated successful episode. The study is relevant to clinical practice because it addresses a common real-world problem rather than treatment-naive migraine. For HCPs, the findings support considering lasmiditan when prior triptans have not delivered adequate relief, while recognising the drug's CNS adverse effects. Patients should be counselled about dizziness, somnolence and activity restrictions after dosing. The broader message is that failure of one acute migraine mechanism does not mean all future acute therapies will fail; alternative pathways can still provide meaningful benefit.
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