Rates and predictors of starting a triptan: results from the American Migraine Prevalence and Prevention Study.

BACKGROUND: Although diagnostic rates for migraine have increased over the past 5 years, the proportion of migraine sufferers using triptans has remained essentially stable.

OBJECTIVES: To assess the rate of onset of new triptan prescriptions among persons with migraine and the predictors of initiating therapy.

METHODS: The American Migraine Prevalence and Prevention Study is a longitudinal study conducted in a representative sample of headache sufferers in the US population. Episodic migraineurs not using triptans in 2005 who continued to have migraine and provided treatment data in 2006 (n=6865) were included. We assessed predictors of triptan use in univariate and multivariate analyses, including 3 nested models. In Model 1, we adjusted for demographic variables. Model 2 added headache-related disability and cutaneous allodynia. Model 3 added depression and use of preventive headache medications.

RESULTS: Among individuals not using triptans in 2005, triptan use in 2006 occurred in 4.9% of the sample. In unadjusted analyses, gender and race were not associated with use of triptan. Use was lower in those aged 60 years or more vs those 18-29 (odds ratio [OR]=0.4, 95% confidence interval [CI]=0.2-0.7, P=.001). Taking individuals with no disability as the reference, mild (OR=1.44, 95% CI=1.03-2.01, P=.03), moderate (OR=1.54, 95% CI=1.1-2.2, P=.01) and severe disability (OR=2.19, 95% CI=1.55-3.09, P<.0001) predicted triptan use. In the adjusted models, age, income, insurance, disability and preventive medication use were associated with triptan use. Gender, race, education and depression were not.

CONCLUSIONS: New use of triptans is low in the population. Because adequacy of care was not assessed, future studies should focus on investigating whether this low rate of triptan start is proper or if it reflects an unmet treatment need.