Use and overuse of triptans in Austria – a survey based on nationwide healthcare claims data

DOI: https://doi.org/10.1186/s10194- 018- 0864- 0

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Abstract-Summary Among the latter 33,062 persons (0.56%) were triptan users and 1970 (0.033%) were triptan overusers.

The estimated proportion of persons with migraine using a triptan was less

than 6%.

Among users 5.9% were overusers of whom 55% overused triptans in ≥2 quar-

ters of 2007.

The median number of days of sick-leave was higher in triptan users than in non- users: due to any reason of sick-leave 12 vs. 10, p < 0.001, due to migraine 3 vs. 2, p < 0.001.

The proportion of hospital admissions did not differ between triptan users and

non-users.

The rate of triptan use is low in Austria but triptan users are at risk for triptan

overuse.

In triptan users more days of sick-leave and the same proportion of hospital

admissions as in the older non-users suggest poorer health.

Extended: The proportion of triptan overusers was highest in Salzburg (10.7%)

and lowest in Styria (3.0%).

The proportion of hospital admissions did not differ between triptan users and

non-users although triptan users were significantly younger than non-users.

The rate of triptan use in Austria was lower than in other studies based on insur-

ance claims.

The rate of triptan overuse was comparable with other countries. The rate of triptan overusers among users was 10% according to IHS criteria and 3.3% according to more restrictive criteria requiring 18 DDD per month over a period of 3 months [605].

Background Acute migraine attacks are treated with analgesics, nonsteroidal anti-inflammatory drugs (NSAIDS), or triptans [606].

It is particularly important in patients with frequent use of acute migraine medi- cation to prevent medication overuse headache which affects approximately 1% of the general population [607].

Their prevalence in patients with migraine was estimated two to 10 times that of

the general population with higher rates in chronic migraine [608].

Older studies reported triptan use in 0.55–1.4% of the populations and overuse in

0.9–14.3% of the users [609–613].

We used the GAP-DRG database to assess the use and overuse of triptans and to explore differences between the nine provinces as well as between urban and rural regions.

We analysed the prescription of migraine prophylactics, antidepressants, and serotonergic drugs, as well as sick leave and hospital admissions in non-users of triptans and users with and without triptan overuse.

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Methods In order to analyse triptans and co-medications dispensed in 2007, we used the GAP-DRG database which includes data from 19 social security institutions in Austria.

We analysed the prescription of drugs used for migraine prophylaxis, antidepres-

sants, and other serotonergic drugs in users and non-users of triptans.

To assess the general health status we compared the number of days of sick-leave and the number of hospital admissions in users and non-users of triptans comparing triptan overusers and non-overusers in the former group.

We calculated Chi2-tests for categorical variables and odds ratios (OR) for com- paring the prescription of co-medication and hospital admissions in non-users of triptans and users without overuse (using non-users as reference) as well as in users without and with overuse (using users without overuse as reference).

Results Triptan users without overuse refilled a median of 12 DDD per year, whereas triptan overusers refilled a median of 102 DDD per year (p < 0.001).

Triptan overusers were significantly older than users without overuse (median 47

vs. 44 years; p < 0.001).

Although triptans are not licensed for the use in persons older than 65 years we identified 1779 triptan users (5.4% of all users) and 164 overusers (8.3% of all over- users) in this age group.

Triptan overuse in one, two, three or four quarters was found in 886 (45%), 409 (20.8%), 313 (15.9%), and 362 (18.4%) persons, whereas the corresponding median DDD (Q1; Q3) per year were 80 (64; 90), 108 (96; 117.5), 132 (120; 148.5), 174 (150; 220).

Discussion A Dutch study found 1.3% triptan users and 0.1% overusers in the general population.

The relation of 0.56% triptan users in our study to a migraine prevalence of 10% reported for Austria many years ago [614] suggests that less than 6% of the patients with migraine are using triptans in our country.

This supports findings of previous studies with prescriptions of antidepressants, prophylactics, and benzodiazepines in about one third of triptan users and even more often in triptan overusers [605, 615].

Comparable to findings of Braunstein and others [615], the days with sick leave

did not differ between triptan users without and with overuse.

To the examination of triptan use and overuse, we were able to assess regional differences, prescription patterns of triptans, prescriptions of co-medications as well as data on sick leave and hospital admissions, and to compare these findings in non- users, users, and overusers of triptans.

Conclusion Citing Leonard Cohen’s “Bird on the Wire”, some migraineurs may need the advice “Why not ask for more?”

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Acknowledgement A machine generated summary based on the work of Zebenholzer, Karin; Gall, Walter; Wöber, Christian. 2018 in The Journal of Headache and Pain.

Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache