How Is Triptan Response Related to Quality of Life Among Migraineurs?

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&thinsp;<.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&thinsp;<.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.
• TIRs had significantly more disability, with higher MIDAS scores (13.2 vs 7.7; P&thinsp;<.001), lower MSQ scores in 3 domains (Role Function Restrictive, 62.4 vs 74.5; Role Function Preventive, 70.0 vs 82.2; Emotional Function, 67.7 vs 82.1; all P <.001), and lower EQ-5D-5L utility scores (0.84 vs. 0.91; P&thinsp;=&thinsp;.001)
• TIRs noted greater impairments in work productivity and activity (absenteeism, 8.6% vs 5.1%, respectively; presenteeism, 34.3% vs 21.0%; work impairment, 37.1% vs 23.3%; overall activity impairment, 39.8% vs 25.3%; all P&thinsp;<&thinsp;.05)
• OTC medication use was significantly greater in TIRs than TRs

Results show “those with an insufficient response to triptan medication have significantly worse HRQoL and higher work productivity burden than those who respond to triptans,” the researchers concluded. “This includes a higher level of disability according to MIDAS, a greater impact across all MSQ domains, lower EQ-5D-5L utility scores, and greater absenteeism and presenteeism.”

Patients with chronic migraine demonstrate greater therapeutic challenges than those with episodic migraine, as they tend to have higher rates of comorbidities that may make adherence to treatment difficult.

“These findings highlight the need for more effective acute migraine treatment and a holistic approach to patient management to help alleviate the burden of migraine in patients who respond insufficiently to triptans,” the researchers said.

Reference

Lombard L, Farrar M, Ye W, et al. A global real-world assessment of the impact on health-related quality of life and work productivity of migraine in patients with insufficient versus good response to triptan medication [published online April 29, 2020]. J Headache Pain. doi:10.1186/s10194-020-01110-9