Triptan Use in Adults with Migraine and CV Risk Factors

A high proportion of adults with migraine use triptans for migraine control, despite having cardiovascular risk factors that are considered to be contraindications to triptan use, according to the results of a study published in Pain Research and Treatment.

“Triptans use, particularly among those with multiple CV risk factors, is concerning and future studies should investigate why triptans are prescribed for these adults and whether such prescriptions are accompanied by systematic and rigorous cardiac evaluations,” wrote Monira Alwhaibi, of West Virginia University, and colleagues.

Triptans are contraindicated in patients with certain cardiovascular risk factors including diabetes, hypertension, hyperlipidemia, obesity, and smoking. However, according to Alwhaibi and colleagues there are few data looking at the rate of triptans use among adults with these cardiovascular risk factors.

“Such knowledge is critical for clinical practice and to reduce harms associated with triptans use among adults with multiple CV risk factors,” they wrote.

To find out more about the rate of triptans use, the researchers used data from the 2009-2013 Medical Expenditure Panel Survey (MEPS) looking at 1,652 adults aged 21 or older with migraine headache. They examined risk factors including diabetes, hypertension, hyperlipidemia, current smoking status, and obesity.

About 61% of the adults in the study had at least one cardiovascular risk factor; 29% had one risk factor, 20.3% had two risk factors, and 11.5% had three or more. According to the researchers, this rate of cardiovascular risk “is consistent with published research in which the risk of cardiovascular risk factors among adults with migraine is higher than those without migraine.”

Overall, 21% of the adults in the study reported triptan use; 25.5% of adults without cardiovascular risk factors used tripans, a rate which the researchers wrote was “somewhat higher than those found in the published literature.”

“The difference in rates of triptans use may be due to differences in study population and the definition of CV risk factors,” they wrote. “AMPP study considered diabetes, hypertension, hyperlipidemia, and current smoking as CV risk factors and included adults over age 64 years.”

Fewer adults with cardiovascular risk factors reported use of triptans compared with those without risk factors (18.1% vs. 25.5%). However, 16.4% of adults with one risk factor, 22.3% of adults with two risk factors, and 14.9% of adults with three or more risk factors still reported use of the drugs.

The researchers found that among adults with migraine, triptans use was not significantly different among adults with only one cardiovascular risk factors as compared to adults with three or more risk factors.

The researchers added that: “FDA’s evidence based clinical practice guidelines and consensus statements recommend that healthcare providers should prescribe triptans with caution to patients with CV risk factors. In addition, FDA recommends a cardiac evaluation to those with multiple risk CV risk factors.”

Reference: Alwhaibi M, et al. Triptans use for migraine headache among nonelderly adults with cardiovascular risk. Pain Res Treat. Epub 2016 Aug 17.