Short-term naratriptan treatment does not worsen pain sensitivity in migraine: a prospective clinical trial

Background Migraine represents one of the most disabling neurological disorders, frequently underdiagnosed and undertreated, with predominant reliance on acute medications that may precipitate medication overuse headache. Evidence indicates that triptans, including naratriptan, modulate central sensitization—a key pathophysiological mechanism in migraine—yet their short-term continuous use requires evaluation regarding impact on pain thresholds. ObjectiveTo investigate whether seven days of continuous naratriptan use alters cephalic pain thresholds in patients with migraine. MethodsProspective study involving 19 patients diagnosed with migraine per International Classification of Headache Disorders (ICHD-3) criteria, recruited from institutions in Barbacena, Minas Gerais, Brazil. Pain thresholds were assessed via pressure algometry (MED.DOR device) at bilateral cephalic sites before and after seven days of naratriptan 2.5 mg every 12 hours, with reassessment two weeks post-treatment. The primary analysis used paired equivalence testing with a prespecified margin of ±20% of the baseline mean.Results Mean overall pressure pain threshold (PPT) increased from 45.12 (SD 17.45) kgf at baseline to 50.56 (SD 16.86) kgf after seven days of treatment and was 51.64 (SD 14.30) kgf at follow-up. The mean paired change after treatment was +5.43 kgf (90% CI, 0.53 to 10.33 kgf). The prespecified equivalence bounds were −9.02 to +9.02 kgf; therefore, statistical equivalence was not demonstrated. The conventional paired comparison was not statistically significant (p=0.070).Conclusion Short-term continuous naratriptan use does not worsen pain sensitivity and may attenuate central sensitization processes in episodic migraine, supporting its safety for exacerbation management. Larger controlled trials are warranted.