Pharmacoepidemiology of triptans in a headache centre

Aims: The aims of this survey were: (i) to examine the pharmacoepidemiology of triptans in a headache centre; (ii) tocompare the characteristics of patients who continued to take triptans with those of patients who had discontinued them.Methods: We enrolled all migraine patients according to ICHD-II criteria, ensuring they were over 18 years of age,consecutively examined during a follow-up visit at the Headache Centre of the University Hospital of Modena fromOctober 2008 to March 2009. Only patients who had used or were using a triptan were included. A specific questionnaireabout the use and tolerability of triptans was created for the study and administered to every patient.Results: On the whole, 343 patients (migraine without aura: 72%; chronic migraine: 26%; migraine with aura: 2%; mean age40.410 years) had used or were using triptans. Most patients (72%) continued to use triptans, above all for their efficacy.The minority (28%) discontinuing them were younger and suffered from less severe migraine; 59% of them had discontinuedtriptans because of adverse effects. Indeed, 92% of these patients versus 57% of patients who were currently usingtriptans reported adverse effects (p<.0001, Fisher’s exact test). The number of patients reporting adverse effectssignificantly decreased with age (r¼0.230, p<.005, simple linear regression analysis). The triptan discontinued by thehighest percentage of patients (84%) was subcutaneous 6 mg sumatriptan. Significantly more patients reported adverseeffects with subcutaneous 6 mg (89%) and tablet 100 mg sumatriptan (67%) than with any other triptan.Conclusions: The increase of the tolerability of triptans with age could partly explain why younger patients suffering from lesssevere migraine tend to discontinue triptans more than older patients suffering from more severe migraine. In the latter, theefficacy and better tolerability (but not necessarily safety) of triptans could foster the overuse of these medications.