Too Many Heart Patients Getting Migraine Drugs

Triptans Taken by 22% of Migraine Sufferers With Heart Problems Who Shouldn't Take Them

By Charlene Laino
WebMD Health News

Reviewed by Laura J. Martin, MD

Sept. 30, 2011 (San Diego) -- A disturbing number of people with heart problems who shouldn't be prescribed standard migraine medications like Amerge, Axert, Frova, Imitrex, Maxalt, Relpax, Treximet, and Zomig are given the drugs anyway, researchers say.

The drugs are all triptans. They're considered very effective for treating migraine headaches and, for many people, the only drugs that work.

But the drugs temporarily narrow blood vessels, so they should not be taken by people with certain heart conditions.

Yet a study of more than 120,000 people with migraines showed that more than one in five with heart conditions that prohibited the use of triptans were given a triptan prescription over a year-long period.

That figure is "very upsetting. I never would have thought it was that high," says Stewart Tepper, MD, a headache specialist at the Cleveland Clinic. Tepper reviewed the findings for WebMD but was not involved with the work.

The findings were presented here at the annual meeting of the American Neurological Association.

Triptans Can Pose Heart Concerns

About 30 million Americans get migraine headaches, according to the Migraine Research Foundation.

Triptans effectively and quickly relieve headache pain, sensitivity to light and noise, and nausea and vomiting associated with migraines. They are especially helpful for people with moderate to severe headaches that interfere with their ability to perform daily tasks.

Triptans narrow (constrict) blood vessels in the brain. For most people, these drugs are well tolerated and safe.

But triptans also temporarily narrow blood vessels leading to the heart -- by 10% to 20%, Tepper tells WebMD. That can make them dangerous for people who already have heart disease, he says.

Less than 1% of patients taking triptans in studies that led to their FDA approval developed cardiovascular problems including heart attack, stroke, life-threatening heart rhythms, and death. But the risk is much higher in people with heart disease.

The drugs' labeling clearly states that people with significant underlying heart disease, a previous heart attack, a history of stroke or transient ischemic attack, peripheral vascular disease, and uncontrolled high blood pressure should not take triptans.

22% With Heart Conditions Given Triptans

The new study aimed to find out how many migraine patients with cardiac conditions that prohibit triptan use are prescribed triptans.

Using data from 10 health plans, researchers identified 121,286 people with migraines.

Of those:

  • 38% had been given one or more prescriptions for a triptan.
  • 8% had a cardiac condition that prohibited the use of triptans.
  • 22% of those with a heart condition that prohibited the use of triptans were given a triptan prescription during 2009.

"If they were given a prescription, it's likely they took the drug," says researcher Daisy Ng-Mak, PhD, director of global health outcomes at Merck Sharp & Dohme Corp. in West Point, Pa., which funded the study.

Tepper says that he has patients with migraines that are only helped by triptans. "When I tell them they can't take the drugs, they get extremely upset," he says.

So what should these people do?

"There's a huge unmet need for a new drug," Ng-Mak says.

As for people with migraines and one or more risk factors for cardiovascular disease, Tepper advises talking to your doctor to determine if you are an appropriate candidate for triptans.

That includes men over 40 and women over 50, people with diabetes, or a family history of heart disease or stroke, and smokers, he says.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.


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SOURCES: 136th Annual Meeting of the American Neurological Association, San Diego, Sept. 28, 2011.Daisy Ng-Mak, PhD, director, global health outcomes, Merck Sharp & Dohme Corp., West Point, Pa.Stewart Tepper, MD, professor, neurology, Cleveland Clinic.

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