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

Abstract

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.

Zavegepant Nasal Spray for Treatment of Acute Migraine: A Systematic Review

“…For example, the use of triptans, a commonly prescribed medication for acute migraine attacks, is limited by the occurrence of cardiovascular events in certain patients [19,20]. Additionally, triptans are contraindicated in patients with uncontrolled hypertension and those with a history of stroke or ischemic heart disease [21,22]. On the other hand, NSAIDs are not effective in all patients and can have adverse gastrointestinal effects, particularly in the long term [23,24].…”

Association between clinician specialty and prescription of preventive medication for young adults with migraine: A retrospective cohort study

“…“Other migraine diagnosis” included menstrual migraine (G43.821, G43.829, G43.831, G43.839), hemiplegic migraine (G43.401, G43.409, G43.411, G43.419), and migraine with persistent aura without infarction (G43.501, G43.509, G43.511, G43.519). These ICD‐10 codes for migraine were adapted from prior studies 12,13 . Each patient could have more than one migraine diagnosis if multiple ICD‐10 codes were assigned.…”

“…These ICD-10 codes for migraine were adapted from prior studies. 12,13 Each patient could have more than one migraine diagnosis if multiple ICD-10 codes were assigned. If a patient had another ICD-10 headache diagnosis in addition to a migraine diagnosis, the patient also received a designation of "other headache diagnosis."…”

Virtual issue: Recent advances in the headache–cerebrovascular disease relationship

“…With the exception of a 2020 narrative review of the relationship of migraine and ischemic stroke, 1 the papers were published in 2021, [3][4][5] 2022, [6][7][8][9][10][11] and early 2023. [12][13][14][15][16] The first section focuses on populations of individuals with migraine (stratified by headache frequency) 3 and with aura or aura-like events, 4,5,9,12 detailing investigations of clinical characteristics and etiologies that may predispose to stroke.…”

“…The second section includes papers examining the relationship of headache and CV events, including migraine as an ischemic stroke risk factor 1,6,16 and headache following aneurysmal subarachnoid hemorrhage 10,11 or cervicocerebral dissection. 14 Papers in the third section focus on cardiovascular risk in persons on migraine therapeutics, specifically triptans 7,8,13 for acute treatment and erenumab, 15 a fully human monoclonal antibody to the calcitonin gene-related peptide receptor, for migraine prevention.…”