ABSTRACT

1
Switching vs. Consistent Triptan Treatment and
Headache-Related Disability Results of the
American Migraine Prevalence and Prevention
(AMPP) Study Dawn C. Buse PhD1 Daniel Serrano
PhD2 Shashi H. Kori MD3 Cedric M. Cunanan MPH4
Aubrey N. Manack PhD4 Michael L. Reed PhD2
Richard B. Lipton MD1 1. Albert Einstein College
of Medicine, Bronx, NY 2. Vedanta Research,
Chapel Hill, NC 3. MAP Pharmaceuticals, Mountain
View, CA 4. Allergan Inc., Irvine, CA
BACKGROUND
RESULTS
Fig. 1. Headache-Related Disability by Treatment
Use Group (Average MIDAS Sum Score)

• Acute pharmacologic treatments for migraine are
  often switched in clinical practice.
• Switch studies have typically focused on
  treatment effects at 2 hours and 24 hours for a
  single attack.
• People with migraine treat multiple attacks over
  long periods of time. Therefore, studies should
  assess the influence of treatment switches on
  clinically meaningful outcomes over longer time
  periods.
• The effects of changes in treatment from one
  triptan to another or from a triptan to another
  medication class have rarely been studied.

• We classified treatment changes in 799 AMPP
  survey respondents with ICHD-2 defined migraine
  who were treated with a triptan in the first year
  of a couplet in the following four treatment
  groups
• 1. Maintaining current triptan (n667)
• 2. Switch to different triptan (n81)
• 3. Switch to a NSAID agent (n20)
• 4. Switch to combination analgesics containing
  opioids
• or barbiturates (n31)
• We observed the following changes in MIDAS score
  over time (couplet) in the four treatment groups
• 1. Maintaining current triptan MIDAS
  decrease -0.4 points
• 2. Switch to different triptan MIDAS no change
• 3. Switch to a NSAID agent MIDAS increase 4.9
  points
• 4. Switch to combination analgesics containing
  opioids
• or barbiturates MIDAS increase
  5.7 points (Figure 1)
• Effects of switching on headache-related
  disability from baseline to the follow up year in
  a couplet varied based on starting average
  headache day/month frequency. In some cases,
  interaction effects were seen. For example,
  switching from a triptan to an NSAID was
  associated with significant increases in
  headache-related disability among those with
  HFEM/CM compared to those with LFEM
  (interaction34.81, 95CI 10.61-59.00) (Figure
  2). The same was true comparing HFEM/CM to those
  with MFEM (interaction48.73, 95CI 2.63-94.83).
• Among those with LFEM, change in headache-related
  disability did not differ between consistent
  users (cell mean 12.3) and those switching to
  NSAIDs (cell mean 12.5). However, those who
  were HFEM/CM experienced increased
  headache-related disability when they switched to
  NSAIDs (cell mean 26.3) vs. those maintaining
  consistent treatment (cell mean -8.7)
  (interaction 34.8, 95CI 10.6-59.0).

OBJECTIVE

• To assess the influence of switching acute
  pharmacologic treatment on headache-related
  disability in a US population sample of
  individuals with migraine currently treated with
  a triptan.

METHODS

• The AMPP study is a longitudinal, US
  population-based study.
• Surveys were mailed to a sample of 24,000 persons
  with severe headache identified in 2004 and
  followed annually through 2009.
• Eligible subjects met ICHD-2 criteria for
  migraine and reported acute treatment with a
  triptan one year and data on treatment and
  outcomes the next year.
• Pairs of adjacent years are herein referred to as
  couplets.
• Patterns of acute pharmacologic treatment for
  migraine were monitored from one year to the next
  for the following couplets
• 2005-2006, 2006-2007, 2007-2008,
  2008-2009
• We classified four medication-change groups
• 1. Maintaining current triptan use (consistent
  group)
• 2. Switching to a different triptan
• 3. Switch to a non-steroidal anti-inflammatory
  (NSAID) agent
• 4. Switch to combination analgesics containing
  opioids or barbiturates
• Respondents with migraine were divided into the
  following groups based on attack frequency
• Low Frequency Episodic Migraine (LFEM)
• 0 to 4 headache-days/month
• Moderate Frequency Episodic Migraine (MFEM)
• 5 to 9 headache-days/month
• High Frequency Episodic Migraine (HFEM)
• 10 to 14 headache-days/month
• Chronic Migraine (CM)

Fig. 2. Difference in Headache-Related Disability
(Average MIDAS Sum Score) Associated with
Switching a NSAID HFEM/CM vs. LFEM
Conclusions

• In this observational study, switching triptan
  regimens or switching from a triptan regimen to
  an alternative pharmacologic therapy for migraine
  did not appear to be associated with improvements
  in headache-related disability, and in some cases
  was associated with increased headache-related
  disability over time.
• Effects of switching treatments on
  headache-related disability appears to be
  influenced by baseline average headache day
  frequency per month. For example, in the
  consistent triptan use group, those with LFEM had
  an increase in disability while those with HFEM
  had a decrease. While for those who switched to
  an NSAID, both the LFEM group and the HFEM group
  had an increase in disability.
• Consideration of headache day frequency may lead
  to improvements in treatment modifications.

The American Migraine Prevalence and Prevention
Study is funded through a research grant to the
National Headache Foundation from Ortho-McNeil
Neurologics, Inc., Titusville, NJ. Additional
analyses and poster preparation were supported by
a grant from MAP Pharmaceuticals, Mountain View,
CA and Allergan Inc., Irvine, CA to the National
Headache Foundation.