Triptans and Ischemic Events: A New Study Parses the Risk
Labeling for triptan medications warns of potential for ischemic events but is the concern theoretical or real? A new study tests the association.
All triptan medications, used for the management of migraine headaches, carry an FDA warning about potential risk for ischemic events including myocardial infarctions (MI) and stroke, however there are questions about whether this warning is more theoretical than based in reality.
The triptans are vasoconstrictors* and therefore it would appear logical that they would carry a risk for these adverse events. Many studies on the relationship, however, have failed to identify such an association.
A recent study approached the question by determining the frequency of ischemic events after initial treatment with a triptan.
*Although the antimigraine effects of triptans are often attributed to this vasoconstrictive effect, the exact mechanism responsible for effects of the drugs on migraine symptoms is still not completely understood.
Participants: 429 000+ participants with an initial prescription fill for a triptan between January 1995 and August 2022 and experienced 1 of 3 ischemic events.
Ischemic outcomes after triptan initiation: Myocardial infarction 11 (0.003%); ischemic stroke 18 (0.004%); nonspecific stroke 35 (0.008%)
Risk factors for ischemia following initiation of triptan medications
Risk of MI or stroke associated with triptan use appears small but real in clinical practice - warranting current labeling cautions
Symptoms of ischemia may have mimicked those of migraine, particularly given that participants who experienced events were older in this study
