Triptanophobia in migraine: A case-control study on the causes and consequences of the non-use of triptans in chronic migraine patients.

Abstract Background Triptanophobia is the excessive and inadequately justified concern about the potential risks of triptans. In this study we evaluate the possible causes of non-use of triptans in chronic migraine patients and the possible consequences. Results We included 941 patients, 86.2% female with a mean age of 39.9 years. Mean number of headache days per month was 24.1. The number of patients using triptans was 247 (26.2%). Triptans had been discontinued due to adverse events in 116 patients (12.3%), so 578 patients (61.4%) were triptan naïve. Formal contraindications were found in 23 patients (2.4%). Frequency of vascular risk factors, contraceptive use or age did not differ between the groups (p > 0.1). Participants with triptans used symptomatic medication fewer days per month (13.9 vs. 17.1, p < 0.001), had used prior prophylactic treatment more frequently (79.4% vs. 34.8%, p < 0.001) and presented symptomatic medication overuse less frequently (55.1% vs. 63.0%, p = 0.03). Conclusion Triptans were not used in three-quarters of chronic migraine patients. Non-use of triptans was not justified by inadequate tolerability, frequency of formal contraindications or frequency of vascular risk factors. Triptan use was associated with a better clinical situation at the moment of referral to a headache unit.