Perinatal use of triptans and other drugs for migraine—A nationwide drug utilization study

Abstract

Objective To characterize nationwide utilization patterns of migraine pharmacotherapy before, during, and after pregnancy in women with triptan use. Methods Population-based data were obtained by linking the Medical Birth Registry of Norway and the Norwegian Prescription Database from 2006 to 2017. We included 22,940 pregnancies among 19,669 women with at least one filled triptan prescription, a proxy for migraine, in the year before pregnancy or during pregnancy. The population was classified into four groups: i) continuers; ii) discontinuers; iii) initiators, and vi) post-partum re-initiators. Participant characteristics and prescription fills for other drugs such as analgesics, antinauseants, and preventive drugs among the groups were examined, along with an array of triptan utilization parameters. Results In total, 20.0% of the women were classified as triptan continuers, 54.1% as discontinuers, 8.0% as initiators, and 17.6% as re-initiators. Extended use of triptans (≥15 daily drug doses/month) occurred among 6.9% of the continuers in the first trimester. The top 10% of triptan continuers and initiators accounted for 41% (95% CI: 39.2% - 42.5%) and 33% (95% CI: 30.3% - 35.8%) of the triptan volume, respectively. Triptan continuers and initiators had similar patterns of acute co-medication during pregnancy, but use of preventive drugs was more common among the continuers before, during, and after pregnancy. Conclusion Among women using triptans before and during pregnancy, one in four continued triptan treatment during pregnancy, and extended triptan use was relatively low. Triptan discontinuation during and in the year after pregnancy was common. Use of other acute migraine treatments was higher among both continuers and initiators of triptans. Women using preventive migraine treatment were most commonly triptan continuers and re-initiators after pregnancy. Prescribing to and counseling of women with migraine should be tailored to the condition severity and their information needs to promote optimal migraine management in pregnancy.

Identification and characterization of migraine in pregnancy: A Norwegian registry-based cohort study

“…Expanding on our previous work (22), we classified migraine severity using drugs as proxies and established the following hierarchical and mutually exclusive categories: i) very mild (a migraine diagnosis, no dispensations); ii) mild (a migraine diagnosis, general analgesics dispensed (i.e., paracetamol, NSAIDs and/or prochlorperazine); iii) moderate (a migraine diagnosis, oral triptans dispensed; and, iv) severe (migraine Dx, preventive drugs and/or triptan injections dispensed). During pregnancy, we added a “very severe” category (preventive drugs) (Online Supplemental Table 1).…”

Association of Maternal Use of Triptans During Pregnancy With Risk of Attention-Deficit/Hyperactivity Disorder in Offspring

“…Prevalence estimates of triptan use during pregnancy among women with migraine vary between 9% and 25% . Many women with migraine discontinue use of triptans during pregnancy or switch to acetaminophen, which is in line with treatment recommendations . However, a substantial proportion of these women report high pain intensity .…”

“…Many women with migraine discontinue use of triptans during pregnancy or switch to acetaminophen, which is in line with treatment recommendations . However, a substantial proportion of these women report high pain intensity . Moreover, untreated maternal migraine has been associated with several pregnancy complications …”

“… 8 However, a substantial proportion of these women report high pain intensity. 6 Moreover, untreated maternal migraine has been associated with several pregnancy complications. 9 …”

“…8 However, a substantial proportion of these women report high pain intensity. 6 Moreover, untreated maternal migraine has been associated with several pregnancy complications. 9 Studies of prenatal exposure to triptans during pregnancy have not found an association with increased risks of malformations.…”