Triptans widely prescribed for migraine but contraindicated in patients with CV conditions

Almost 5 million Americans with episodic migraine (EM) should not be prescribed a triptan, the only class of acute medications FDA approved and developed for migraine, because of the presence of cardiovascular contraindications, according to results from the American Migraine Prevalence and Prevention (AMPP) Study.

The results of the study were presented in June at the 2013 International Headache Congress in Boston.

“Triptans are widely prescribed and effective; however their use is contraindicated with persons with cardiovascular [CV] event histories and conditions,” according to Dawn Buse, PhD, associate professor of neurology, Albert Einstein College of Medicine, Montefiore Headache Center, New York City. “This leaves a substantial number of individuals without safe and effective treatment for migraine. Awareness of this unmet need and the resulting need for safe and effective therapies for this large group of patients is vital to the effective care of persons with migraine.”

This study analyzed 6,723 (1,496 males, 5,227 females) patients with (EM; ICHD-2 defined migraine with headache on average <15 days per month) from the AMPP Study, a longitudinal, US-population-based study to determine rates of rates CV contraindications to triptan use in the AMPP Study sample and estimate rates in the general US population.

Of 11,799 respondents to the 2009 AMPP Study survey, 6,723 (1,496 males, 5,227 females) met criteria for EM. CV events or procedures were reported by 11.1% of those aged <40 (n=1,457), 18.7% of those 40-59 (n=3,716) and 33.6% of those ≥60 (n=1,550). Males had slightly higher rates for events and procedures across all age strata (Table).

Census-based projections of net CV events and procedures yielded 4.71 million persons with EM in the US (1.17 million males and 3.54 million females) where triptan use may be contraindicated.

Respondents to the 2009 AMPP Study reported prior CV contraindications (events: myocardial infarction, TIA, stroke, claudication and angina; procedures: coronary angioplasty, stenting or bypass surgery, carotid artery surgery or stenting, and peripheral artery bypass surgery). ICHD-2 criteria were used to identify EM cases (ICHD-2 migraine diagnosis with average <15 headache days/month). The sample was stratified by sex and age (<40, 40-59, and ≥60). Frequency counts were generated for each CV event and procedure. Observed rates for CV contraindications were applied to US Census-derived estimates of EM for each age strata. Modified Framingham Risk scores (derived from self-reported data on diabetes, hypertension, smoking, cholesterol, body mass index [BMI], sex, and age) identified persons free of events and procedures at high risk for silent myocardial ischemia.