Treatment Choices and Patterns in Migraine Patients With and Without a Cardiovascular Risk Profile

Abstract

Treatment patterns in migraine patients with cardiovascular risk factors are largely unknown. A retrospective observational study was conducted to characterize the baseline cardiovascular risk profile of new users of specific abortive migraine drugs, and to investigate treatment choices and patterns in patients with and without a known cardiovascular risk profile. New users of a triptan, ergotamine or Migrafin (n = 36,839) from 1 January 1990 to 31 December 2006 were included. Approximately 90% of all new users did not have a clinically recognized cardiovascular risk profile. The percentage of new users with a cardiovascular risk profile did not differ between new users of a triptan, ergotamine or Migrafin and also did not change during the study period of 17 years. Differences in treatment choices and patterns between migraine patients with and without a known cardiovascular risk profile reveal a certain reticence in prescribing vasoconstrictive antimigraine drugs to patients at cardiovascular risk.

Ergot Use and Overuse: A Pharmacoepidemiology Retrospective Cohort Study

“…It has been previously reported that 90% of new users of ergotamine or triptans did not have a clinically recognized cardiovascular risk profile. 18 However, special attention should be paid to older patients in particular with cardiovascular risk.…”

“…However, older migraineurs who were used to consuming ergots before the marketing of triptans and find them efficient may continue to use ergots for the treatment of their migraine attacks. It has been previously reported that 90% of new users of ergotamine or triptans did not have a clinically recognized cardiovascular risk profile . However, special attention should be paid to older patients in particular with cardiovascular risk.…”

The Role of Cardiovascular Screening in Headache Patients

“…An additional pharmacy database search of 72,743 patients treated with a triptan, ergotamine, or ibuprofen over 16 years in the Netherlands led those authors to conclude that there was no compelling evidence of the association between cardiovascular adverse events and triptan use in patients with known cardiovascular risk factors. They go on to suggest that consideration of treatment of this class of patients with triptans may improve their quality of life 22 …”