Department of Neurology, Medical University of Vienna, Vienna, Austria.
Institute of Medical Information Management, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Headache. 2022 May;62(5):604-612. doi: 10.1111/head.14304.
To gather information about prescription of triptans and to evaluate whether vascular comorbidity differs in users and nonusers of triptans over the age of 50 years.
Beyond the age of 50 years, migraine is still common-yet the incidence of vascular disorders increases. Triptans, medications for treating migraine attacks, are vasoconstrictive drugs and contraindicated in persons with vascular disorders.
Based on a nationwide insurance database from 2011, we compared the prescription of vascular drugs (identified by Anatomical Therapeutic Chemical codes), vascular diagnoses and hospitalizations, between triptan users greater than 50 years and a matched control group.
Of the 3,116,000 persons over 50 years, 13,833 (0.44%) had at least one triptan prescription; 11,202 (81%) were women. Thirty percent of the triptan users (13,833/47,336 persons) were over 50 years. Of those over 50 years, 6832 (49.4%) had at least one vascular drug and 870 (6.3%) had at least one inpatient vascular diagnosis; 15.7% (2166 of 13,833 users) overused triptans. We compared triptan-users to 41,400 nonusers, using a 1:3 match. In triptan-users, prescriptions of cardiac therapies and beta blockers were significantly more common (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.24-1.47 and OR = 1.19, 95% CI = 1.14-1.25, respectively); whereas prescriptions of calcium channel blockers and renin/angiotensin inhibitors were significantly less common (OR = 0.82, 95% CI = 0.76-0.88 and OR = 0.75, 95% CI = 0.72-0.79, respectively). The prescriptions of antihypertensive, diuretic, and antilipidemic drugs as well as platelet inhibitors and direct thrombin inhibitors did not differ in users and nonusers. Triptan users had significantly more hospital stays (OR = 1.39, 95% CI = 1.33-1.45); however, the number of days spent in the hospital and more importantly the frequency of inpatient vascular diagnoses did not differ statistically significantly between the two groups.
In persons over 50 years of age, a prescription of triptans is common. Vascular comorbidity is comparable in users and nonusers of triptans showing that triptans are prescribed despite vascular comorbidity and suggesting that triptan use does not increase vascular risk in patients with migraine over the age of 50 years. Nevertheless, regular evaluation for contraindications against triptans and for vascular risk factors is recommended in this age group.
收集关于曲坦类药物处方的信息，并评估 50 岁以上患者中曲坦类药物使用者和非使用者的血管合并症是否存在差异。
50 岁以上人群仍常见偏头痛，但血管疾病的发病率增加。曲坦类药物是治疗偏头痛发作的药物，属于血管收缩药物，禁忌用于有血管疾病的患者。
基于 2011 年的一项全国性保险数据库，我们比较了 50 岁以上曲坦类药物使用者和匹配对照组之间血管药物（通过解剖治疗化学代码识别）、血管诊断和住院治疗的处方情况。
在 50 岁以上的 311.6 万人中，有 13833 人（0.44%）至少有一次曲坦类药物处方；其中 11202 人（81%）为女性。曲坦类药物使用者的 30%（13833/47336 人）年龄在 50 岁以上。在 50 岁以上人群中，有 6832 人（49.4%）至少使用过一种血管药物，870 人（6.3%）至少有一次血管住院诊断；15.7%（2166/13833 名使用者）过度使用曲坦类药物。我们将曲坦类药物使用者与 41400 名非使用者进行了 1:3 匹配比较。在曲坦类药物使用者中，心脏治疗和β受体阻滞剂的处方明显更为常见（比值比[OR] 1.35，95%置信区间[CI] 1.24-1.47 和 OR 1.19，95% CI 1.14-1.25）；而钙通道阻滞剂和肾素/血管紧张素抑制剂的处方明显减少（OR 0.82，95% CI 0.76-0.88 和 OR 0.75，95% CI 0.72-0.79）。在使用者和非使用者中，抗高血压药物、利尿剂、抗血脂药物、血小板抑制剂和直接凝血酶抑制剂的处方没有差异。曲坦类药物使用者的住院次数明显更多（OR 1.39，95% CI 1.33-1.45）；然而，住院天数以及更重要的是住院血管诊断的频率在两组之间没有统计学上的显著差异。
在 50 岁以上人群中，曲坦类药物的处方很常见。血管合并症在曲坦类药物使用者和非使用者中相似，这表明尽管存在血管合并症，仍开具了曲坦类药物，提示曲坦类药物的使用不会增加 50 岁以上偏头痛患者的血管风险。然而，建议在该年龄组定期评估曲坦类药物的禁忌证和血管危险因素。
