Ergot and Triptan Overuse in Austria - an Evaluation of Clinical Data and Cost

Abstract

Austria is one of the countries, in which ergots are still the most commonly used acute anti-migraine drugs. Overuse and chronification is a clinical problem for ergots, but also for the recently developed triptans. In a retrospective study for the year 1999 we evaluated clinical data from all Austrian neurological hospitals including cost of withdrawal as well as the estimated cost for ergots and triptans on the pharmaceutical retail market. We identified a total of 96 patients that underwent withdrawal, all of whom because of ergot overuse, and some with considerable long-term side-effects. The cost of withdrawal (more than 1300 000) together with direct cost of medication amounted to more than 11 million. In contrast, cost of medication for triptans was 12.8 million for the same year, without any cost for withdrawal. If only cost aspects were to be considered in the prescription of acute anti-migraine drugs, our data would suggest to choose ergots rather than triptans. However, as scientific evidence is clearly in favour of triptans, decision making for the prescribing clinicians is more complex and will primarily focus on optimizing patient care, but also depend on the respective socio-economic situation.

Ergot Use and Overuse: A Pharmacoepidemiology Retrospective Cohort Study

“…In the literature, ergot users and ergot overusers are notably older than other migraineurs. Medication overuse headache can lead to several somatic complications, most of which are caused by the side effects of the overused drugs.…”

Triptan overuse in the Dutch general population: A nationwide pharmaco-epidemiology database analysis in 6.7 million people

“…Attacks typically last 1-2 days and strike with a median frequency of 1.5 per month; 10% of patients have two or more attacks per week (6). A high attack frequency is associated with a substantial increase of disability (4,7,8), costs (5,9), and risk of ischemic brain lesions (10,11). Overuse of acute headache agents is increasingly recognized as a paradoxical but major reason for sometimes dramatic increases in the attack frequency (medication-overuse headache) (7,(12)(13)(14)(15).…”

“…With the increasing availability of triptans over the counter and the currently often advocated (21) but still unproven instruction to treat attacks as early as possible while the headache is still mild, the prevalence of triptan overuse headache is likely to increase. This might have a major impact on the quality of life of migraine patients (22,23) and will cause a considerable increase in costs (9).…”

Reference programme: Diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 2nd Edition, 2012

“…MOH was originally described in 1951 by Peter and Horton of the Mayo Clinic, MN, USA on the basis of ergotamine overuse [49]. MOH has subsequently been described regularly in association with all analgesics including opioids and more specific migraine drugs such as triptans [47, 48, 50, 51]. Combination drugs containing codeine, caffeine and/or barbiturates generally carry a higher risk of MOH than simple analgesics and NSAIDs [47, 48, 50, 51].…”

“…According to the criteria, the patient must have experienced a minimum of 15 days with headache within the last 3-month period, but in practice these patients typically present after many years with daily headaches and frequent migraine-like attacks [48, 50, 53]. According to the criteria, the headache must have developed during the medication overuse period, or the primary headache shall have aggravated markedly, but it is often difficult to obtain this information as these chronic headaches may have persisted for a very long period of time.…”