Triptans for Acute Migraine: Drug Class Review to Help Inform Policy Decisions

Knowles, Sandra R.; Oh, Paul; Gomes, Tara

doi:10.1111/head.12594

Cited by 4 publications

(4 citation statements)

References 17 publications

(23 reference statements)

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“…Simple analgesics such as paracetamol, acetylsalicylic acid, antiemetic drugs such as metoclopramide, NSAIDs, triptans can be used in acute treatment [45,[47][48][49]. However, it is also critically important to minimize potential for acute overuse treatment as this would invariably lead to MOH [50].…”

Section: Acute Treatmentmentioning

confidence: 99%

Prevalence of Migraine in the Elderly: A Narrated Review

2019

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Migraine is one of the most prevalent neurological disorders among all age groups including the elderly, but the incidence and prevalence of migraine tend to decrease with age. The clinical phenotype of migraine also appears to be different in the elderly patient group in comparison to the younger patient group, with elderly migraine appearing to be more often bilateral and associated with what has become known as “late-life migraine accompaniments. Furthermore, difficulty in the differentiation of migraine from vascular insults such as transient ischemic attacks and amyloid angiopathy and other multiple comorbidities, polypharmacy and age-related changes in pharmacodynamics and pharmacokinetics makes treatments for this cohort challenging but necessary, especially given the worldwide increase in life expectancy, and likelihood of migraine continuing to be a major personal and public health problem.

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Section: Acute Treatmentmentioning

confidence: 99%

Prevalence of Migraine in the Elderly: A Narrated Review

2019

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“…This program is much less restrictive than the EAP as it only requires authorization by a medical practitioner who can verify a patient meets the specific criteria to access the drug. Direct billing is performed at the pharmacy, meaning patients do not have to engage in a lengthy application process similar to the EAP, or pay out of pocket 12,15 …”

Section: Definitionsmentioning

confidence: 99%

“…Drugs that are approved under the ODB in the general formulary are deemed safe and cost effective and can be accessed by eligible individuals with a prescription from a licenced physician in Ontario without issue 11,12 …”

Section: Definitionsmentioning

confidence: 99%

“…The EAP requires patients to apply for coverage that is either granted for a limited amount of time, or denied 13 . The reason that many drugs are not readily covered by the ODB is that they are expensive and/or lack sufficient clinical evidence to support their use 12,14 . The application process can be quite involved, requiring patients to meet rigid prescribing criteria that is documented by their attending physician.…”

Section: Definitionsmentioning

confidence: 99%

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Access to Migraine Treatments in Ontario, Canada: A Review of the Ontario Drug Benefit Program

Cape

2020

Headache

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Background.-This paper provides a critical review of the decision-making process of the Ontario Ministry of Health and Long-Term Care (MOHLTC) regarding which migraine treatment drugs will be covered under the Ontario Drug Benefit Formulary (ODB). Main Text.-Under MOHLTC policy, triptans and OnabotulinumtoxinA are available to patients only through the Exceptional Access Program (EAP). This policy, and justifications for it, are examined with reference to clinical guidelines, patient experiences, and health policy literature. The contexts and consequences of compromised access are outlined. Improvements in access to these treatments are suggested by highlighting how a country with similar healthcare infrastructure-Australia-employs policies that more adequately meet the needs of migraine patients as they secure treatments. Conclusions.-Despite clinically significant gains in the discovery of safe and effective migraine-specific treatments the ODB thus far has failed to align its practice with current clinical recommendations. This forces patients to rely heavily on medication that, while still effective for some, is potentially suboptimal. This review concludes it is prudent, at minimum, to follow clinical recommendations that advocate for the removal of triptans from EAP and recategorize them as Limited Use drugs. Ideally, moving them to a general benefit would further remove the barriers experienced by patients attempting to access this treatment.

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