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Triptan non-response in a London tertiary headache centre: What can we learn? A retrospective study
Robyn-Jenia Wilcha1, Peter J Goadsby1,2
1NIHR King's Clinical Research Facility, SLaM Biomedical Research Centre, and Wolfson Sensory, Pain and Regeneration Centre, King's College London, London, UK.
Cephalalgia : an International Journal of Headache
|September 9, 2024
Summary
Many migraine patients do not respond to triptans, with over 60% showing non-response. Clinicians should consider alternative acute treatments like gepants or ditans for better migraine management.
Area of Science:
- Neurology
- Pharmacology
Background:
- Triptans are a cornerstone in acute migraine treatment, but patient responses vary significantly due to efficacy and tolerability issues.
- The European Headache Federation (EHF) has established standardized definitions for triptan non-response, yet prevalence data remain limited.
Purpose of the Study:
- To evaluate the prevalence of triptan non-response, triptan resistance, and triptan refractoriness in a real-world clinical setting.
- To identify factors associated with triptan non-response in adult migraine patients.
Main Methods:
- A two-year service evaluation of clinic letters from a London-based tertiary headache service.
- Inclusion of 419 adult migraine patients to assess triptan response based on EHF definitions.
Main Results:
- A high prevalence of triptan non-response (63.8%) was observed, with 37.7% classified as triptan resistant and 4.6% as triptan refractory.
- Advancing age and medication overuse were linked to increased triptan response, while more failed preventive treatments and use of CGRP monoclonal antibodies correlated with triptan non-response.
- Eletriptan showed the highest response rate (49.5%), followed by nasal zolmitriptan (44.4%) and rizatriptan (35.7%).
Conclusions:
- The study reveals a concerningly high rate of triptan non-response in adult migraineurs treated at a tertiary headache service.
- Clinicians must optimize acute treatment by considering alternative triptans, early intervention, or different drug classes such as gepants or ditans.
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