Effects of switching acute treatment on disability in migraine patients using triptans.

Abstract

OBJECTIVE:

To assess the influence of switching acute treatment on headache-related disability in a population sample of individuals with migraine using acute triptan therapy.

BACKGROUND:

Acute treatments for migraine are often modified in clinical practice. The effect of changes in treatment from one triptan to another or from a triptan to another medication class has rarely been studied.

METHODS:

Patterns of acute treatment for migraine were monitored from 1 year to the next in the American Migraine Prevalence and Prevention (AMPP) Study for the following couplets (2005-2006, 2006-2007, 2007-2008, and 2008-2009). Changes in medication regimens were classified as follows: (1) switch within the triptan class; (2) switch to combination analgesics containing opioids or barbiturates; (3) switch to non-steroidal anti-inflammatory drug (NSAID) agents; (4) maintaining current therapy (consistent use, "control"). We assessed change in migraine disability assessment scale score from the first to the second year of a couplet contrasting those with consistent use with those who changed acute treatment. Each individual contributed only 1 couplet to the analysis. Persons who added an acute treatment are considered in a separate manuscript. We modeled change in migraine disability assessment scale score as a function of change in medication regimen with consistent users as the control group.

RESULTS:

We identified 81 individuals who switched to another triptan, with a referent of 619 who remained consistent, 31 cases who switched to an opioid or barbiturate with a referent of 666 who remained consistent, and 20 cases who switched to an NSAID with a referent of 667 cases who remained consistent. In cell-mean coded analyses of covariance (ANCOVA), switching from one triptan to another or switching from a triptan to an opioid/barbiturate was never associated with significant improvements in headache-related disability compared with consistent treatment. Switching from a triptan to an NSAID was associated with significant increases in headache-related disability among those with high-frequency episodic/chronic migraine (HFEM/CM) compared with those with low-frequency episodic migraine (LFEM) (interaction = 34.81, 95% confidence interval 10.61 to 59.00). The same was true comparing high-frequency episodic/chronic migraine with those with moderate-frequency episodic migraine (interaction = 48.73, 95% confidence interval 2.63 to 94.83).

CONCLUSIONS:

In this observational study, switching triptan regimens does not appear to be associated with improvements in headache-related disability and in some cases is associated with increased headache-related disability.

• Authors: Daniel Serrano, Dawn C Buse, Shashi H Kori, Sypridon Papapetropoulos, Cedric M Cunanan, Aubrey N Manack, Michael L Reed, Richard B Lipton
• Journal: Headache (Headache) Vol. 53 Issue 9 Pg. 1415-29 (Oct 2013) ISSN: 1526-4610 [Electronic] United States
• PMID: 23808937 (Publication Type: Journal Article)
• Copyright: © 2013 American Headache Society.

Chemical References

• Analgesics, Opioid
• Anti-Inflammatory Agents, Non-Steroidal
• Tryptamines

Topics

• Adult
• Analgesics, Opioid (administration & dosage)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage)
• Drug Substitution (methods, trends)
• Female
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Migraine Disorders (drug therapy, epidemiology)
• Population Surveillance (methods)
• Treatment Outcome
• Tryptamines (administration & dosage)