Triptans and vascular comorbidity in persons over fifty: Findings from a nationwide insurance database – A cohort study

Abstract

ObjectiveTo gather information about prescription of triptans and to evaluate whether vascular comorbidity differs in users and nonusers of triptans over the age of 50 years.BackgroundBeyond the age of 50 years, migraine is still common—yet the incidence of vascular disorders increases. Triptans, medications for treating migraine attacks, are vasoconstrictive drugs and contraindicated in persons with vascular disorders.MethodsBased on a nationwide insurance database from 2011, we compared the prescription of vascular drugs (identified by Anatomical Therapeutic Chemical codes), vascular diagnoses and hospitalizations, between triptan users greater than 50 years and a matched control group.ResultsOf the 3,116,000 persons over 50 years, 13,833 (0.44%) had at least one triptan prescription; 11,202 (81%) were women. Thirty percent of the triptan users (13,833/47,336 persons) were over 50 years. Of those over 50 years, 6832 (49.4%) had at least one vascular drug and 870 (6.3%) had at least one inpatient vascular diagnosis; 15.7% (2166 of 13,833 users) overused triptans. We compared triptan‐users to 41,400 nonusers, using a 1:3 match. In triptan‐users, prescriptions of cardiac therapies and beta blockers were significantly more common (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.24–1.47 and OR = 1.19, 95% CI = 1.14–1.25, respectively); whereas prescriptions of calcium channel blockers and renin/angiotensin inhibitors were significantly less common (OR = 0.82, 95% CI = 0.76–0.88 and OR = 0.75, 95% CI = 0.72–0.79, respectively). The prescriptions of antihypertensive, diuretic, and antilipidemic drugs as well as platelet inhibitors and direct thrombin inhibitors did not differ in users and nonusers. Triptan users had significantly more hospital stays (OR = 1.39, 95% CI = 1.33–1.45); however, the number of days spent in the hospital and more importantly the frequency of inpatient vascular diagnoses did not differ statistically significantly between the two groups.ConclusionIn persons over 50 years of age, a prescription of triptans is common. Vascular comorbidity is comparable in users and nonusers of triptans showing that triptans are prescribed despite vascular comorbidity and suggesting that triptan use does not increase vascular risk in patients with migraine over the age of 50 years. Nevertheless, regular evaluation for contraindications against triptans and for vascular risk factors is recommended in this age group.

Triptan use in elderly over 65 years and the risk of hospitalization for serious vascular events

“…Some studies have assessed the relationship between triptans and cardiovascular events [2,[5][6][7][8][9]. They concluded either in the absence of risk or a moderately increased risk of vascular events, but none of these studies considered older age.…”

Triptan non-response in specialized headache care: cross-sectional data from the DMKG Headache Registry

“…Of those being eligible for triptan treatment, 30 to 60% do not have a 2 h response (headache improvement) to a specific triptan, and up to 40% have recurrence after initial pain freedom [ 2 ]. While severe adverse events are extremely rare [ 5 ], fatigue, dizziness, paresthesias and chest tightness may result in discontinuation or limited use of triptans. Persistence with triptan treatment is low both internationally [ 6 ] and in Germany, where health insurance data show that 60% of migraine patients discontinue their triptan, often after the first prescription [ 3 ].…”

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.…”