Abstract and Introduction
Objective: We sought to investigate the prevalence of triptan use among patients with migraine who have contraindications to triptan usage, and to explore specifics of the medication prescribed, dosage, and route of administration.
Background: Triptan medications are a mainstay of acute migraine therapy, but little is known about prevalence and patterns of triptan prescribing among patients with contraindications in the United States.
Methods: In this retrospective cohort study, we used data from the IBM Marketscan database to identify patients aged ≥ 18 years with migraine from January 1, 2016, to December 31, 2017, using International Classification of Diseases, Clinical Modification 10 codes. Contraindications to triptan medications were identified by review of package labels as listed on the US Food and Drug Administration website. Triptan medications were identified from the IBM Micromedex Redbook linked to prescription claims along with route of administration and dosage.
Results: Of 1,038,472 individuals diagnosed with migraine, 400,112 (38.5%) were prescribed triptan medication, and of those who were prescribed a triptan, 55,707 (13.9%) had at least one contraindication, with the most common contraindication being cardiac arrhythmia (33,696/400,112 individuals, 8.4%) followed by cerebrovascular disease (14,787/400,112, 3.7%) and coronary artery disease (10,236/400,112, 2.6%). Sumatriptan was the most prescribed triptan (261,736/1,038,472, 25.2%), and the subcutaneous and intranasal routes were more commonly prescribed among those with contraindications compared with those without contraindications.
Discussion: A substantial proportion of patients with migraine with contraindications were prescribed triptan medications. These findings call for further research on the outcomes of patients with medical contraindications who are prescribed triptan medications, and for greater clarity in prescribing guidelines about the optimal approach for acute therapy among patients with migraine.
Migraine headache affects 47 million people in the United States and greater than 1 billion people worldwide.[1,2] Migraine is the sixth most disabling illness globally and the second most disabling illness in individuals of prime working years aged 30–50 years. Lost productivity due to migraine headache is estimated to cost $36 billion annually in the United States, with individuals with migraine needing 2.2 more sick days on average each year than those without migraine. Considering the large global burden and impact of migraine, safe and effective treatments are essential. Migraine can be treated with either preventative or abortive medications, and triptan medications (5-HT1B/1D receptor agonists) are the most common migraine-specific abortive medication, with sumatriptan being the most commonly used. One estimate of triptan use among those with migraine found that 17.7% of women and 14.3% of men used triptans.
Although triptan medications are a mainstay for acute migraine therapy, they have been associated with stroke and other adverse cardiovascular events, especially for those who have comorbidities or risk factors that already predispose them to such events.[3,6] As a result, the US Food and Drug Administration (FDA) has listed contraindications to triptan use on package labels, including but not limited to prior cardiovascular and cerebrovascular disease. No prior study has examined triptan use among those with contraindications as reported by the FDA. In addition, there are limited data about triptan dosage and route of administration among people with migraine who have contraindications to triptan usage. Given the severity of the possible adverse advents associated with triptan use, these data need to be explored.
We sought to compare the characteristics of individuals with migraine taking triptan medications to those not taking triptans using a nationwide, contemporary database with information from inpatient and outpatient encounters and prescriptions. We sought to describe how commonly patients with triptan contraindications were prescribed these medications and explored data on dosage and route of administration.
Headache. 2022;62(7):883-889. © 2022 Blackwell Publishing