Insufficient response to triptans is associated with poor health-related quality of life (HRQoL) and lower work productivity in migraineurs compared with those who respond well to the medications, according to a study published in The Journal of Headache and Pain.
Triptans are the most commonly prescribed agents for acute treatment of migraine. However, although generally effective, triptans “are insufficiently efficacious in 30% to 40% of patients and poorly tolerated by or contraindicated in others.” In addition, lack of response to acute medications has been associated with increased risk of progression from episodic to chronic migraine.
To determine whether suboptimal HRQoL and reduced work productivity are present in patients whose migraines do not respond to triptans, researchers assessed data from the 2017 Adelphi Migraine Disease Specific Program (DSP). The cross-sectional survey included responses from primary care physicians, neurologists, headache specialists, and their patients with migraine.
Surveys completed by participants included the Migraine-Specific Quality of Life questionnaire (MSQ), the EuroQol 5-Dimensions 5-Levels questionnaire (EQ-5D-5L), the Migraine Disability Assessment questionnaire (MIDAS), and the Work Productivity and Activity Impairment questionnaire: Migraine.
Over 1000 triptan-treated patients were divided into triptan insufficient responders (TIRs), who achieved freedom from headache pain within 2 hours of acute treatment in a maximum of 3?of 5 migraine attacks (n = 483), and triptan responders (TRs), who achieved freedom from pain within 2 hours in?at least 4?of 5 attacks (n = 930).
Deidentified DSP data were collected from survey participants in the United States, France, Germany, Italy, Spain, and Denmark. Researchers found TIRs were more likely to be older, female, and have experienced cardiovascular disease. Anxiety, stress, sleeping disorders, and depression were also more prevalent in TIRs compared with TRs (P?<.01).
Preventive medication was prescribed to 46% of patients overall, with significantly more TIRs than TRs currently receiving preventive agents. The most commonly prescribed agents were topiramate, propranolol, and metoprolol.
The study also yielded these results:
- TIRs were more likely to have chronic migraine (?15 headache days/month) than TRs (11.6% vs 3.2%, respectively; P?<.001).
- Symptoms associated with migraine, including sensitivity to light, sound, and smell; nausea; vomiting; and bilateral pain were significantly more common in TIRs than TRs.