Epidemiology, Demographics, Triptan Contraindications, and Prescription Patterns of Patients with Migraine: A German Claims Database Study

Abstract

Introduction: Migraine is a neurological disease with a considerable economic and societal burden that negatively impacts quality of life and productivity. Triptans are potent serotonin receptor agonists widely used to treat migraine attacks. Little is known about German patients with migraine diagnosed with triptan contraindications or those who discontinue triptans. Methods: This retrospective observational study identifies adults with migraine from a German sickness fund database (2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). Migraine prevalence was calculated for the database population and extrapolated to the German Statutory Health Insurance (SHI) population. Medication use, proportion and demographics of patients with triptan contraindications, prevalence of triptan discontinuation and use of triptans by patients with contraindications were analysed.Results: In total 120,170 patients with migraine were identified in the database population, of whom 77.7% were female; migraine prevalence was 2.0% (male) and 7.3% (female), leading to an extrapolated 2,923,979 patients with migraine in the entire German SHI population (2019); of these, 14.5% had C 1 triptan contraindication. The most frequent contraindication was a history of stroke/transient ischaemic attack. However, an extrapolated 25.9% of patients who had a triptan contraindication received a triptan prescription following diagnosis. We calculated that 975,698 patients in the entire German SHI population had ever received a triptan, of whom 596,364 did not receive a triptan prescription in the follow-up year. Of these 596,364 individuals, 96.6% continued to receive a migraine diagnosis after their last triptan prescription. These 'triptan discontinuers' were predominantly female (82.6%). Most patients utilized only one specific triptan, with a large majority of ongoing triptan users who had used this specific triptan receiving [ 4 prescriptions. Conclusion: We confirm the existence of German patients with migraine and unmet therapeutic needs. These are patients diagnosed with triptan contraindications or patients who have discontinued triptan use despite continued migraine attacks. More research is needed to ascertain reasons for triptan discontinuation and the risk of triptan use by patients with contraindications.

Place of next generation acute migraine specific treatments among triptans, non-responders and contraindications to triptans and possible combination therapies

“…and in hemiplegic migraine and migraine with brainstem aura (4,42). As migraine, mainly with aura, is linked to a wide range of ischemic vascular disorders including myocardial infarction and ischemic stroke, contraindications may be relevant in some migraine patients (42)(43)(44)(45). Based on a retrospective analysis among commercially insured adults in the US, contraindications for triptans were reported in up to 20% of migraine patients.…”

Triptan medication use among patients with migraine with contraindications in the US

“…Using administrative data among patients with migraine in Germany from 2010 to 2018, extrapolation to the general German population was performed 18 . Of the patients with migraine, 14.5% had contraindications to triptan medication, most commonly history of stroke or transient ischemic attack (6.1%), and contraindications were more common with increasing age.…”

“…Germany from 2010 to 2018, extrapolation to the general German population was performed. 18 Of the patients with migraine, 14.5% Potential reasons why providers prescribe medications for patients with contraindications include not investigating if the patient has contraindications and not knowing the contraindications for the medication. 24 In the Acute Migraine Triptan Guidelines, the American Headache Society suggests evaluating for risk factors, such as coronary heart disease, diabetes, obesity, severe uncontrolled hypertension, or hypercholesterolemia, before prescribing triptans.…”

Evaluation of simple antioxidant blood parameters in patients with migraine

“…In this study, the serum levels of ALB, TBIL, CRE, and UA were significantly lower in the migraine group than in the HC group, indicating an association between oxidative stress and migraine. Several epidemiological studies on migraine have demonstrated that the prevalence of migraine in women is higher than in men ( 30 ). As shown in Table 4 , by the sex subgroup analysis, the serum CRE and ALB levels of female patients were lower than those of male patients, suggesting weaker antioxidant capacity in women, which may provide a new perspective for explaining the higher incidence of migraine in women.…”