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

Abstract

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).

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