A real-world study on unmet medical needs in triptan-treated migraine: prevalence, preventive therapies and triptan use modification from a large Italian population along two years

Abstract

BackgroundAlthough migraine is a disabling neurological condition that causes important disability, it remains an area of underdiagnosis and undertreatment worldwide. The aim of this study was to depict the burden of the unmet medical needs in migraine treated with triptans in a large Italian population.MethodsA 2-year longitudinal analysis of migraineurs with unmet medical needs on treatment with triptans was performed. The studied cohort consisted of subjects with ≥4 triptan dose units per month, selected from the general population These patients were stratified into: possible Low-Frequency Episodic Migraine (pLF-EM: 4–9 triptan dose units per month), possible High-Frequency Episodic Migraine (pHF-EM: 10–14 triptan dose units per month) and possible Chronic Migraine (pCM:> 14 triptan dose units per month). The first follow-up year was analysed to describe the use of preventive therapies, the second year to describe the ≥50% reduction in triptan use.ResultsOf 10,270,683 adults, 8.0 per 1000 were triptan users and, of these, 38.2% were migraineurs with unmet medical needs, corresponding to 3.1 per 1000 adults. By stratifying for the number of triptan dose units per month, 72.3% were affected by pLF-EM, 17.4% by pHF-EM, and 10.3% by pCM. In this cohort, 19.1% of individuals used oral preventive drugs and 0.1% botulinum toxin. Triptan use reduction was found in 22.3% individuals of the cohort, decreasing with the intensification of need levels (25.8% pLF-EM, 13.6% pHF-EM, 12.0% pCM).ConclusionsThis real-life analysis underlined that the unmet medical needs concern a large part of patients treated with triptans and there is an undertreatment with preventive therapies whose benefit is insufficient, which may be due to the lack of effective preventive strategies, probably still reserved to severe patients. This study allows forecasting the actual impact of newest therapeutic strategies aimed to fill this gap.

Failure of Preventive Treatments in Migraine: An Observational Retrospective Study in a Tertiary Headache Center

“…Effects of preventive treatments on migraine frequency. There was only a mild effect on headache frequency in the three months following preventive drugs prescription, in accord to previous studies based on indirect evidence (3,16,20). This could suggest that there is a bias between Randomized…”

“…General considerations on headache populations These real life data showed that in our south Italy tertiary headache center, the most of patients suffered from medium-high frequency migraine, not previously treated with preventive drugs, and only a minority of them used triptans. An Italian study [3] showed that only a minority of patients using triptans and worthy of prophylaxis, assumed preventive drugs, that means that they did not have access to headache specialist or center, or that they had scarce compliance to the prescribed treatment, or they withdraw for adverse events. Our impression is that the most of patients were addressed to our center for a medium-high frequency migraine that was previously underestimated, though worthy of preventive treatment and triptans prescription.…”

Failure of preventive treatments in migraine: an observational retrospective study in a tertiary headache center

“…These real-life data show that in our tertiary headache center in South Italy, most of the patients suffered medium-high frequency migraine, they were not previously treated with preventive drugs, and only a minority of them used triptans. An Italian study [3] showed that only a minority of patients using triptans and that qualified for prophylaxis used preventive drugs. Therefore, they did not have access to headache specialists or centers, minimally complied with the prescribed treatment, or withdrew because of adverse events.…”

“…In the same population, amitriptyline was the most prescribed drug, followed by topiramate (6.3%), propranolol (3.3%) and atenolol (2.7%). The rate of improvement was estimated on the basis of the reduction in triptan use; the use of triptans was even significantly lower among subjects treated with oral preventive therapies than among those without these drugs, though mild improvement was present in the group with chronic migraine [3]. The study underlined that the current use of preventive therapies is limited and has negligible benefits and that most migraine patients currently have unmet needs.…”

“…Migraine is a common and disabling disease, affecting approximately 12-14% of the occidental population [1]. Despite the criteria of acute episodes, treatment and prevention having been well described [2], there is still a large proportion of patients with unmet needs, general underuse and low benefits of preventive treatments [3]. National guidelines indicate the conditions for the prescription of preventive treatment, the drugs with evidence of action and consequent recommendations for their use [2].…”