Triptan non-response in a London tertiary headache centre: What can we learn? A retrospective study.

Autor: Wilcha RJ; NIHR King's Clinical Research Facility, SLaM Biomedical Research Centre, and Wolfson Sensory, Pain and Regeneration Centre, King's College London, London, UK., Goadsby PJ; NIHR King's Clinical Research Facility, SLaM Biomedical Research Centre, and Wolfson Sensory, Pain and Regeneration Centre, King's College London, London, UK.; Department of Neurology, University of California, Los Angeles, CA, USA.
Jazyk: angličtina
Zdroj: Cephalalgia : an international journal of headache [Cephalalgia] 2024 Sep; Vol. 44 (9), pp. 3331024241278911.
DOI: 10.1177/03331024241278911
Abstrakt: Background: Triptans revolutionized the acute treatment of migraine; however, varied responses to triptans, as a result of poor efficacy and tolerability, are reported. A standardized definition of triptan non-response was recently proposed by the European Headache Federation (EHF). There is currently limited data available on the prevalence of triptan non-response.
Methods: We used clinic letters over a two-year duration to evaluate the triptan response and triptan efficacy or tolerability failure, or both, in a London-based tertiary headache service.
Results: In total, 419 adult migraine patients (females: 83.8%, age: 46 ± 18 years, chronic migraine: 88.5%) were included in a service evaluation. In line with the EHF definitions, "triptan non-response" was seen in 63.8% of patients (264/414), whereas 37.7% of patients (156/414) had failed at least two triptans (EHF "triptan resistant") and 4.6% of patients (19/414) had failed at least three triptans, including a subcutaneous formulation (EHF "triptan refractory"). Notably, 21.3% of patients (88/414) had failed at least three triptans inclusive and exclusive of subcutaneous triptan use. Advancing age ( p  < 0.001) and the presence of medication overuse ( p  = 0.006) increased the probability of triptan response, whereas an increased number of failed preventives ( p  < 0.001) and the use of calcitonin gene-related peptide monoclonal antibodies ( p  = 0.022) increased the probability of triptan non-response. The largest proportion of patients responded to eletriptan (49.5%), followed by nasal zolmitriptan (44.4%) and rizatriptan (35.7%).
Conclusions: Our findings highlight an alarming prevalence of triptan non-response among adult migraineurs receiving treatment in a London-based tertiary headache service. It is imperative for clinicians to explore methods to optimize acute medication efficacy, whether this comprises changing to a triptan with a superior response rate, advocating for early intervention or considering alternative acute medication classes, such as gepants or ditans.
Competing Interests: Declaration of conflicting interestsRW has nothing to declare. PJG reports, over the last 36 months, grant from Kallyope, and personal fees from Aeon Biopharma, Abbvie, Aurene, CoolTech LLC, Dr Reddy's, Eli-Lilly and Company, Linpharma, Lundbeck, Pfizer, PureTech Health LLC, Satsuma, Shiratronics, Teva Pharmaceuticals, Tremeau, and Vial.
Databáze: MEDLINE
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