Abstract
ABSTRACT Background: Triptanophobia is the excessive and inadequately justified concern about potential risks of triptans. We evaluated causes and consequences of nonuse of triptans in chronic migraine (CM) Methods: Case-control study. We included CM patients firstly referred to aheadache unit. Patients were cases or controls depending on whether they were triptan naïve, or not. We analyzed if nonuse of triptans was justified by formal contraindications or adverse events. We assessed if triptan naïve patients had higher frequency of vascular risk factors (VRF), contraceptive drugs or older age. Results: We included 941 patients, 247 (26.2%) triptan users. Triptans had been discontinued due to tolerability in 116 patients (12.3%), being 578 patients (61.4%) triptan naïve. Formal contraindications were found in 23 patients (2.4%). Frequency of VRF, contraceptive drugs or age did not differ between the groups (p > 0.1). Triptan users consumed symptomatic medications fewer days/month (13.9 vs 17.1, p < 0.001), were under prophylactic treatment more frequently (79.4% vs 34.8%, p < 0.001) and had medication overuse headache less frequently (55.1% vs. 63.0%, p = 0.03). Conclusion: Triptans were not used by three-quartersof CM patients. Nonuse of triptans was not justified by tolerability, frequency of contraindications, or frequency of VRF. Expert opinion: In the present study, we evaluated causes and consequences of the nonuse of triptans in CM sufferers. We analyzed frequency of triptan use in CM patients. We compared, between triptan users and triptan naïve patients, the presence of contraindications, frequency of vascular risk factors, and differences in management prior to the referral to a headache unit.
Highlights
Acute patient relief is a keystone of migraine management
Triptans were not used in three-quarters of chronic migraine patients
Non-use of triptans was not justified by inadequate tolerability, frequency of formal contraindications or frequency of vascular risk factors
Summary
Acute patient relief is a keystone of migraine management. Symptomatic treatment aims to abort migraine episodes and restore patients’ normal function, minimizing migraine morbidity and impact. Different symptomatic treatments have been used[1], representing triptan discovery a new era with more robust studies and better clinical results[2]. Triptans are indicated in acute episodes of migraine with moderate to severe intensity, inadequate response or contraindication to other analgesics[3,4]. Triptans should be prescribed in every person with migraine, in particular those with chronic migraine (CM)[4]. Triptanophobia is the excessive and inadequately justified concern about the potential risks of triptans. In this study we evaluate the possible causes of non-use of triptans in chronic migraine patients and the possible consequences
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