Triptan non-response in specialized headache care: cross-sectional data from the DMKG Headache Registry

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung

Beitragende

  • Ruth Ruscheweyh - , Klinikum der Ludwig-Maximilians-Universität (LMU) München (Autor:in)
  • Gudrun Gossrau - , Universitäts SchmerzCentrum (Autor:in)
  • Thomas Dresler - , Universitätsklinikum Tübingen (Autor:in)
  • Tobias Freilinger - , Klinikum Passau (Autor:in)
  • Stefanie Förderreuther - , Klinikum der Ludwig-Maximilians-Universität (LMU) München (Autor:in)
  • Charly Gaul - , Headache Center Frankfurt (Autor:in)
  • Torsten Kraya - , Hospital Sankt Georg Leipzig gGmbH (Autor:in)
  • Lars Neeb - , Helios Kliniken Gruppe (Autor:in)
  • Victoria Ruschil - , Eberhard Karls Universität Tübingen (Autor:in)
  • Andreas Straube - , Klinikum der Ludwig-Maximilians-Universität (LMU) München (Autor:in)
  • Jörg Scheidt - , Hochschule für Angewandte Wissenschaften Hof (Autor:in)
  • Tim Patrick Jürgens - , Universitätsmedizin Rostock (Autor:in)

Abstract

BACKGROUND: Triptans are effective for many migraine patients, but some do not experience adequate efficacy and tolerability. The European Headache Federation (EHF) has proposed that patients with lack of efficacy and/or tolerability of ≥ 2 triptans ('triptan resistance') could be considered eligible for treatment with the novel medications from the ditan and gepant groups. There is little data on the frequency of 'triptan resistance'.

METHODS: We used patient self-report data from the German Migraine and Headache Society (DMKG) Headache Registry to assess triptan response and triptan efficacy and/or tolerability failure.

RESULTS: A total of 2284 adult migraine patients (females: 85.4%, age: 39.4 ± 12.8 years) were included. 42.5% (n = 970) had failed ≥ 1 triptan, 13.1% (n = 300) had failed ≥ 2 triptans (meeting the EHF definition of 'triptan resistance'), and 3.9% (n = 88) had failed ≥ 3 triptans. Compared to triptan responders (current use, no failure, n = 597), triptan non-responders had significantly more severe migraine (higher frequency (p < 0.001), intensity (p < 0.05), and disability (p < 0.001)), that further increased with the level of triptan failure. Responders rates were highest for nasal and oral zolmitriptan, oral eletriptan and subcutaneous sumatriptan.

CONCLUSION: In the present setting (specialized headache care in Germany), 13.1% of the patients had failed ≥ 2 triptans. Triptan failure was associated with increased migraine severity and disability, emphasizing the importance of establishing an effective and tolerable acute migraine medication. Acute treatment optimization might include switching to one of the triptans with the highest responder rates and/or to a different acute medication class.

TRIAL REGISTRATION: The DMKG Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081).

Details

OriginalspracheEnglisch
Aufsatznummer135
FachzeitschriftThe Journal of headache and pain
Jahrgang24
Ausgabenummer1
PublikationsstatusVeröffentlicht - 10 Okt. 2023
Peer-Review-StatusJa

Externe IDs

PubMedCentral PMC10563311
Scopus 85173613203

Schlagworte

Schlagwörter

  • Adult, Female, Humans, Middle Aged, Cross-Sectional Studies, Headache/drug therapy, Migraine Disorders/drug therapy, Tryptamines/therapeutic use, Serotonin 5-HT1 Receptor Agonists/therapeutic use