Prevalence of Acute Medication Use, Overuse, and Discontinuation Among Patients With Migraine

Taking a look at how people with migraine treat their attacks, studies presented at the PAINWeek conference in Las Vegas, Nevada, assessed medication use among the patient population.

While one study found that use and over use of acute medications is common among migraineurs, another found that few patients with acute migraine take triptans, and among those who do, many discontinue the drug due to side effects.

The first study assessing medication use and overuse in patients with migraine included 216,674 patients with prevalent migraine during 2016. Current guidelines for the condition recommend individualized pharmacological management of acute attacks, as well as preventive measures as needed.

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Researchers observed that the majority (83.5%) of patients had at least 1 claim for an acute medication. Of these patients, nearly half (49.7%) had a claim for triptans, 46.9% had a claim for opioids, 44.3% had a claim for NSAIDS/acetaminophen, and 14.2% had a claim for barbiturates. The average duration of medication use was 116 days. Among the different medications, patients using triptans had the longest duration with 99 days, followed by opioids with 67 days.

Over the study period, 15.7% of patients had overused triptan therapy, 9.7% had overused opioids, and 3.8% had overused barbiturates. Among those with at least 1 day of treatment with triptans, 31.5% had overused the medication, and of those with at least 1 day of treatment with opioids, 20.7% had overused the medication.

“Effective treatment options that can help to reduce acute medication use are needed in the management of patients with migraine,” wrote the researchers. “Understanding current utilization and overuse of acute medications among patients with migraine will better inform potential interventions to improve patient care and outcomes.”

Narrowing in on triptan use, specifically, a second study at the conference assessed triptan use and discontinuation in a migraine population. The therapy comes in oral, injectable, and nasal forms, and can therefore be used in various ways by a single patient.

The study population included 15,133 patients with an average migraine frequency of 3.3 days per month. Among the patients, 5596 (37%) had ever used triptans, 1241 (8.2%) had used more than 1 method of administration, and 272 (1.8%) had used all 3 forms. The majority of patients who had used triptans used the oral form (84.7%), 16.5% used nasal spray, and 9.1% used the injectable form.

“Although considered the gold-standard of treatment for acute migraine, only 37% of survey respondents had sued a triptan and 15.9% were current users,” noted the researchers.

The researchers observed high rates of discontinuation among all 3 forms, with the highest discontinuation rates seen with the injectable form (81.5%) followed by nasal sprays (66.5%) and oral medications (55.2%). The most common reason for discontinuation was lack of efficacy, followed by side effects such as dizziness, nausea, and fatigue.

Reference:

PAINWeek abstract book 2018 [published online August 23, 2018]. Taylor & Francis. doi: https://doi.org/10.1080/00325481.2018.1512253.