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. 2023 Oct 10;24(1):135.
doi: 10.1186/s10194-023-01676-0.

Triptan non-response in specialized headache care: cross-sectional data from the DMKG Headache Registry

Ruth Ruscheweyh  1   2   3 , Gudrun Gossrau  4 , Thomas Dresler  5   6   7 , Tobias Freilinger  8 , Stefanie Förderreuther  9 , Charly Gaul  10 , Torsten Kraya  11   12 , Lars Neeb  13 , Victoria Ruschil  14 , Andreas Straube  9 , Jörg Scheidt  15 , Tim Patrick Jürgens  16   17
Affiliations

Triptan non-response in specialized headache care: cross-sectional data from the DMKG Headache Registry

Ruth Ruscheweyh et al. J Headache Pain. .

Abstract

Background: Triptans are effective for many migraine patients, but some do not experience adequate efficacy and tolerability. The European Headache Federation (EHF) has proposed that patients with lack of efficacy and/or tolerability of ≥ 2 triptans ('triptan resistance') could be considered eligible for treatment with the novel medications from the ditan and gepant groups. There is little data on the frequency of 'triptan resistance'.

Methods: We used patient self-report data from the German Migraine and Headache Society (DMKG) Headache Registry to assess triptan response and triptan efficacy and/or tolerability failure.

Results: A total of 2284 adult migraine patients (females: 85.4%, age: 39.4 ± 12.8 years) were included. 42.5% (n = 970) had failed ≥ 1 triptan, 13.1% (n = 300) had failed ≥ 2 triptans (meeting the EHF definition of 'triptan resistance'), and 3.9% (n = 88) had failed ≥ 3 triptans. Compared to triptan responders (current use, no failure, n = 597), triptan non-responders had significantly more severe migraine (higher frequency (p < 0.001), intensity (p < 0.05), and disability (p < 0.001)), that further increased with the level of triptan failure. Responders rates were highest for nasal and oral zolmitriptan, oral eletriptan and subcutaneous sumatriptan.

Conclusion: In the present setting (specialized headache care in Germany), 13.1% of the patients had failed ≥ 2 triptans. Triptan failure was associated with increased migraine severity and disability, emphasizing the importance of establishing an effective and tolerable acute migraine medication. Acute treatment optimization might include switching to one of the triptans with the highest responder rates and/or to a different acute medication class.

Trial registration: The DMKG Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081).

Keywords: Acute headache treatment; Germany; Headache; Migraine; Patient-reported outcome measures; Registry; Triptan failure.

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Conflict of interest statement

RR has received travel grants and/or honoraria for lectures or advisory boards from Allergan/AbbVie, Hormosan, Lilly, Lundbeck, Novartis and Teva.

GG has received honoraria from Lilly, Novartis Pharma, Teva, Lundbeck, and research grants from Novartis Pharma during the last 3 years. She does not hold any stocks of pharmaceutical companies.

TD has received honoraria for consulting and lectures from Hormosan Pharma, Novartis Pharma, and TEVA.

TF received honoraria for advisory boards from Novartis, Teva and Lundbeck and honoraria for lectures from Novartis, Teva, Lilly, Bayer and UCS.

SF received honoraria from Allergan/AbbVie, Hormosan, Eli Lilly, Lundbeck, Novartis, Sanofi and Teva. She served on Advisory Boards for Hormosan, Eli Lilly, Lundbeck, Novartis, Sanofi and Teva.

CG has received honoraria for consulting and lectures within the past 3 years from Abbvie, Lilly, Novartis Pharma, Hormosan Pharma, Grünenthal, Sanofi-Aventis, Lundbeck, Perfood, Reckitt and TEVA. His research is supported by a grant of the German Research Foundation (DFG). He does not hold any stocks of pharmaceutical companies. He is honorary secretary of the German Migraine and Headache Society.

TK has received travel grants and/or honoraria from Allergan/AbbVie, Hormosan, Lilly, Novartis and Teva.

LN received honoraria for lectures and advisory boards vrom Hormosan, Lilly, Novartis, Teva, AbbVie/Allergan.

VR received the Soyka award as a research grant from Novartis.

AS has received honoraria for adboards and educational talks from Allergan/AbbVie, Allergosan, Lilly, Lundbeck, Novartis, Sanofi, Teva.

JS declares no conflict of interest.

TPJ has received honoraria from Allergan/AbbVie, Grünenthal, Hormosan, Lilly, Lundbeck, Novartis, Sanofi and Teva. He served on Advisory Boards and/or consulted for Allergan/AbbVie, Hormosan, Lilly, Lundbeck, Novartis and Teva.TPJ has received honoraria from Allergan/AbbVie, Grünenthal, Hormosan, Lilly, Lundbeck, Novartis, Sanofi and Teva. He served on Advisory Boards and/or consulted for Allergan/AbbVie, Hormosan, Lilly, Lundbeck, Novartis and Teva.

Figures

Fig. 1
Fig. 1
Triptan failure and no failure subgroups
Fig. 2
Fig. 2
Comparison between triptan failure and no failure subgroups. MIDAS, Migraine disability assessment. */**/*** indicate significance at the p < 0.05/0.01/0.001 level in the Bonferroni-corrected post-hoc test
Fig. 3
Fig. 3
Proportions of patients having used or using specific triptans within the study population
Fig. 4
Fig. 4
Frequency of response and reasons for failure of specific triptans. A Triptan responders. For each triptan, bars illustrate percentages of patients having responded to this triptan with respect to all patients who tried this triptan. B Reasons for triptan failure. Bars indicate percentages of patients having failed this triptan for tolerability or efficacy reasons with respect to all patients who tried this triptan, respectively. Note that a patient can have both tolerability and efficacy failure for the same triptan. Percentages for frovatriptan appear artificially low because > 50% of patients discontinued frovatriptan for other reasons. Complete data including discontinuation for other reason are given in Supplementary Table 4
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Comment in

  • Gibt es überhaupt Triptan-Nonresponder?
    Diener HC. Diener HC. MMW Fortschr Med. 2024 Apr;166(6):26. doi: 10.1007/s15006-024-3786-6. MMW Fortschr Med. 2024. PMID: 38581504 Review. German. No abstract available.

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