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Triptans in migraine

The risks of stroke, cardiovascular disease, and death in practice

Gillian C. Hall, PhD, Martin M. Brown, MD FRCP, Jingping Mo, MD PhD and Kenneth D. MacRae, PhD

From Institute of Neurology (Dr. Brown), University College London, UK; and Safety Evaluation and Epidemiology (Dr. Mo), Pfizer Inc., New York, NY. Dr. Hall is an independent researcher.

Address correspondence and reprint requests to Dr. G. Hall, Grimsdyke House, Ravenscroft Park, Barnet, EN5 4ND, UK; e-mail: gillian_hall{at}gchall.demon.co.uk

Background: Triptans are widely used to treat migraine but have been associated with stroke, myocardial infarction (MI), and ischemic heart disease (IHD) in case reports.

Objective: To estimate the incidence of stroke, cardiovascular events, and death in a migraine cohort, stratified by triptan prescription, and investigate whether the risk of these events was increased in those treated with triptans.

Methods: Migraine patients and matched nonmigraine control subjects were identified from the General Practice Research Database. Computerized records were searched for triptan prescriptions, stroke, TIA, MI, IHD, death, arrhythmia, and confounding variables. Incidence rates were calculated and migraine groups compared with controls using a Cox model, adjusting for confounders.

Results: Of 63,575 migraine patients, 13,664 were prescribed a triptan. There was no association between triptan prescription and stroke (hazard ratio [HR] 1.13; 95% CI 0.78, 1.65), MI (HR 0.93; 95% CI 0.60, 1.43), or other outcomes studied. The larger group of migraine patients not prescribed a triptan had an increased risk of stroke (HR 1.51; 95% CI 1.26, 1.82) and IHD (HR 1.35; 95% CI 1.18, 1.54) and a decreased risk of all-cause mortality (HR 0.72; 95% CI 0.65, 0.80).

Conclusions: In general practice, triptan treatment in migraine does not increase the risk of stroke, MI, cardiovascular death, IHD, or mortality. Triptans are prescribed to those less at risk of these events.

Received June 20, 2003. Accepted in final form October 28, 2003.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the February 24 issue to find the title link for this article.

Deceased.

Dr. Hall has received funding for research and payment for consultancy from several pharmaceutical companies. Dr. Brown has received an honorarium from Pfizer for end-point adjudication in a stroke prevention trial unrelated to migraine treatment. Dr. Mo is an employee of Pfizer Inc.

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