Cardiovascular risk and triptan usage among patients with migraine.

Background: Migraine, a neurovascular disorder evident by recurrent headaches, is associated with increased risk of ischemic vascular events, including ischemic stroke and myocardial infarction. Triptans, acute migraine-specific treatment, cause vasoconstriction, complicating treatment decisions, especially for patients with migraine with cardiovascular risk factors. This study examined associations between triptan usage and cardiovascular (CV) events in patients with migraine.

Methods: This retrospective, population-based cohort study conducted in southern Israel utilized data from Clalit Health Services. Electronic medical records from January 2000 to January 2022 were analyzed to assess triptan usage and CV events within 90 days post-purchase among patients aged ≥18 years with a diagnosis of migraine based on International Classification of Diseases, Ninth Revision codes or triptan claims. Sensitivity analyses accounted for varying timeframes and usage patterns.

Results: Among 26,054 patients with migraine, 12,560 (48.2%) initiated triptan therapy. The prevalence of CV risk factors including dyslipidemia, diabetes mellitus, hypertension, smoking, atrial fibrillation, and obesity was higher in the non-triptan group (standardized mean difference [SMD] = 0.028-0.289). The mean (standard deviation) number of triptan pills used per month was 1.9 (1.5), with most patients (89.5%) using 1-4 pills/month. CV events within 90 days occurred slightly more in the triptan group (5.1%) compared to the non-triptan group (4.1%, SMD = 0.047). Multivariable analysis revealed no significant association between triptan use and increased CV events (adjusted hazard ratio 0.96, 95% confidence interval 0.77-1.23), controlling for demographic variables and CV risk factors. Sensitivity analyses also showed no significant risk with triptan use across different timeframes and usage patterns, reinforcing these findings. In the triptan group, patients with CV events were more likely to use triptans frequently, with a higher average number of pills per month.

Conclusions: This retrospective, population-based study found that triptan usage did not increase CV risk among patients with migraine, even in those with existing CV risk factors, where no formal contraindication exists. The study highlights the importance of considering individual risk factors when prescribing triptans, as certain subgroups may still be at higher risk.