Triptans for Migraine - When Do Patients Use Them?

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Migraine medications need to be taken properly in order for them to work well. Migraine abortive medications, such as the triptans (Imitrex, Maxalt, Zomig, etc.) work best when taken early in the migraine attack and may not work at all if taken later. Research presented at the 2015 annual scientific meeting of the American Headache Society showed that migraine patients are more likely to take triptans when pain is mild and throbbing or unilateral.

The Research:

Research Background:

"Adherence to acute treatment recommendations are essential to optimizing migraine care. Triptans (or other migraine specific medications) are considered the best first-line acute intervention assuming they are safe and tolerable for the individual. Despite the integral importance of medication adherence to successful pharmacotherapy, a paucity of research exists examining medication adherence among those with migraine, especially as it pertains to triptan adherence during specific headache attacks assessed in real/near time across multiple attacks."1

Research Methods:

  • In this observational, naturalistic, prospective study, 267 patients with migraine who were prescribe and took a triptan for at least one migraine attack completed a web-based migraine diary daily for at least 30 days.
  • On days when they had a migraine, patients recorded:
    • attack severity
    • disability level
    • attack symptoms
    • associated symptoms
    • acute medication use

Research Results:

  • 57.2% of migraine attack were treated with a triptan.
  • Average reported disability during a migraine was significantly lower on days when a triptan was taken.
  • Attack characteristics were predictive of triptan adherence.
  • Patients were more likely to take a triptan when:
    • pain severity was mild versus moderate or severe.
    • nausea was present.
    • experiencing photophobia.
    • pain was pulsing or throbbing.
    • pain was unilateral.

Research Conclusion:

"The current findings suggest that patients fail to take a triptan for more than four out of every 10 migraine attack days. Disability is lower on days when the the patient takes a triptan. Predictors of a patient taking a triptan are predicted by nausea, photophobia, pulsating/throbbing pain, and unilateral pain. Triptan adherence is a significant issue when assessed in real time and understanding what factors predict the likelihood of taking a triptan can help providers know how to educate patients to actively manage their migraine attacks."1

Comments and Implications for Patients:

Patients were more likely to take a triptan when:

  • pain severity was mild versus moderate or severe.
  • nausea was present.
  • experiencing photophobia.
  • pain was pulsing or throbbing.
  • pain was unilateral.

I find a couple of the above curious, but many of them make sense. The study results make me wonder if at least part of the issue is patients being able to differentiate between a migraine and a headache. Especially since triptans are expensive, and most insurance companies limit how many doses they pay for, many patients hesitate to take triptans if they're not sure they're having a migraine as opposed to a headache.

Another significant factor may well be poor communication between patients and their doctors. As stated in the research conclusion, "This study provides important information that can help providers know how to educate patients to actively manage their migraine attacks." Still, let's be honest about this. Such education is unlikely to occur when patients see doctors who don't specialize in or, at the very least, have a keen interest in treating migraine.

That said, this research does provide valuable insight. We don't have to leave it all to doctors to improve the education we receive from our doctors. If we're not absolutely certain that we understand how to use our medications, as well as other issues related to our migraine management, it's on us to ask the questions we need to ask to achieve that understanding.

More Helpful Information:


Sources:

1 Nicholson, Robert. "Longitudinal Real and Near-Time Assessment of Acute Medication Adherence During Migraine Attacks." Research Presentation; 57th Annual Scientific Meeting of the American Headache Society. Washington, D.C. June, 2015.

2 Press Release. "Migraine Patients More Likely to Take Triptan Medications When Their Pain Is Mild and is Throbbing or Unilateral."

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