Migraine and the Excessive Dispensation of Triptans: A Real-World Evidence Study of Colombian Patients

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Abstract
Background: The aim of this study was to determine the use and safety of triptans in a group of patients with migraine who had excessive dispensings of antimigraine drugs. Methods: This was a cross-sectional study of patients with excessive dispensings of triptans identified by a pharmaceutical manager. The DrugBank database was used to determine rational amounts of triptans. Results: A total of 9147 patients used triptans, 44.6% of whom received excessive dispensings. A sample of 355 patients was selected, 22.8% of whom received regular doses of triptans daily. Adverse events were common (41.1%), and some patients experienced chronic headache (32.4%) and medication-overuse headache (MOH) (8.2%). Increasing age [adjusted odds ratio (aOR): 1.042; 95% confidence interval (CI): 1.008–1.077], a history of migraine for more than 10 years (aOR: 3.73; 95% CI: 1.37–10.16), previous dispensings of simple analgesics (aOR: 2.463; 95% CI: 1.001–6.057), and concomitant psychiatric illnesses (aOR: 3.583; 95% CI: 1.452–8.844) were associated with a higher probability of MOH. Conclusions: In this study conducted in a middle- to low-income Latin American country, triptans were commonly dispensed for patients with migraine, and their dosage did not comply with the recommendations of clinical practice guidelines for some patients. Increasing age, history of migraine ≥10 years, previous use of simple analgesics, and the presence of concomitant psychiatric disorders were associated with a higher probability of MOH. These findings reflect prescribing and dispensing patterns within the studied health-care context and may not fully represent the use of over-the-counter triptans or practices in other settings.

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