Rates and Predictors of Starting a Triptan: Results From the American Migraine Prevalence and Prevention Study

Authors

  • Marcelo E. Bigal MD, PhD,

    1. From the Office of the Chief Medical Officer, Merck, Upper Gwynedd, PA, USA (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal, R. Lipton, and D.C. Buse); Montefiore Medical Center – Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton and D.C. Buse); Merck & Co., Inc. – Outcomes Research & Management, West Point, PA, USA (Y-T. Chen); Merck & Co., Inc. – Global Outcomes Research, Whitehouse Station, NJ, USA (W. Golden); Vedanta Research – Clinical Research, Chapel Hill, NC, USA (D. Serrano); Department of Neurology, Sacred Heart Hospital, Hallym, Korea (Y-T. Chen).
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  • Dawn C. Buse PhD,

    1. From the Office of the Chief Medical Officer, Merck, Upper Gwynedd, PA, USA (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal, R. Lipton, and D.C. Buse); Montefiore Medical Center – Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton and D.C. Buse); Merck & Co., Inc. – Outcomes Research & Management, West Point, PA, USA (Y-T. Chen); Merck & Co., Inc. – Global Outcomes Research, Whitehouse Station, NJ, USA (W. Golden); Vedanta Research – Clinical Research, Chapel Hill, NC, USA (D. Serrano); Department of Neurology, Sacred Heart Hospital, Hallym, Korea (Y-T. Chen).
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  • Ya-Ting Chen PhD,

    1. From the Office of the Chief Medical Officer, Merck, Upper Gwynedd, PA, USA (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal, R. Lipton, and D.C. Buse); Montefiore Medical Center – Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton and D.C. Buse); Merck & Co., Inc. – Outcomes Research & Management, West Point, PA, USA (Y-T. Chen); Merck & Co., Inc. – Global Outcomes Research, Whitehouse Station, NJ, USA (W. Golden); Vedanta Research – Clinical Research, Chapel Hill, NC, USA (D. Serrano); Department of Neurology, Sacred Heart Hospital, Hallym, Korea (Y-T. Chen).
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  • Wendy Golden MSci,

    1. From the Office of the Chief Medical Officer, Merck, Upper Gwynedd, PA, USA (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal, R. Lipton, and D.C. Buse); Montefiore Medical Center – Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton and D.C. Buse); Merck & Co., Inc. – Outcomes Research & Management, West Point, PA, USA (Y-T. Chen); Merck & Co., Inc. – Global Outcomes Research, Whitehouse Station, NJ, USA (W. Golden); Vedanta Research – Clinical Research, Chapel Hill, NC, USA (D. Serrano); Department of Neurology, Sacred Heart Hospital, Hallym, Korea (Y-T. Chen).
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  • Daniel Serrano PhD,

    1. From the Office of the Chief Medical Officer, Merck, Upper Gwynedd, PA, USA (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal, R. Lipton, and D.C. Buse); Montefiore Medical Center – Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton and D.C. Buse); Merck & Co., Inc. – Outcomes Research & Management, West Point, PA, USA (Y-T. Chen); Merck & Co., Inc. – Global Outcomes Research, Whitehouse Station, NJ, USA (W. Golden); Vedanta Research – Clinical Research, Chapel Hill, NC, USA (D. Serrano); Department of Neurology, Sacred Heart Hospital, Hallym, Korea (Y-T. Chen).
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  • Min Kyung Chu MD, PhD,

    1. From the Office of the Chief Medical Officer, Merck, Upper Gwynedd, PA, USA (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal, R. Lipton, and D.C. Buse); Montefiore Medical Center – Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton and D.C. Buse); Merck & Co., Inc. – Outcomes Research & Management, West Point, PA, USA (Y-T. Chen); Merck & Co., Inc. – Global Outcomes Research, Whitehouse Station, NJ, USA (W. Golden); Vedanta Research – Clinical Research, Chapel Hill, NC, USA (D. Serrano); Department of Neurology, Sacred Heart Hospital, Hallym, Korea (Y-T. Chen).
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  • Richard B. Lipton MD

    1. From the Office of the Chief Medical Officer, Merck, Upper Gwynedd, PA, USA (M. Bigal); Albert Einstein College of Medicine – Neurology, Bronx, NY, USA (M. Bigal, R. Lipton, and D.C. Buse); Montefiore Medical Center – Montefiore Headache Center, Bronx, NY, USA (R.B. Lipton and D.C. Buse); Merck & Co., Inc. – Outcomes Research & Management, West Point, PA, USA (Y-T. Chen); Merck & Co., Inc. – Global Outcomes Research, Whitehouse Station, NJ, USA (W. Golden); Vedanta Research – Clinical Research, Chapel Hill, NC, USA (D. Serrano); Department of Neurology, Sacred Heart Hospital, Hallym, Korea (Y-T. Chen).
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  • Funding support: The American Migraine Prevalence and Prevention Study is funded through a research grant to the National Headache Foundation from Ortho-McNeil Neurologics, Inc., Titusville, NJ. Additional analyses, writing, and preparation of this manuscript supported by Merck Pharmaceuticals.

  • Conflicts of Interest: Drs. Bigal, Chen, and Golden are full-time employees of Merck. They hold stocks and stock options of Merck.

M. Bigal, Head of the Merck Investigator Studies Program and Scientific Education Group.
UG3CD-68, 351 North Sumneytown Pike, Upper Gwynedd, PA 19454.

Abstract

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.

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