Severe vascular events in migraine patients.
OBJECTIVE
To estimate rates of vascular events in relation to dispensing of triptans and ergot alkaloids among migraineurs, and to compare these rates with those of nonmigraineurs.


BACKGROUND
It has been speculated that the use of triptans or ergot alkaloid drugs might increase risk of ischemic events through vasoconstriction.


METHODS
A retrospective cohort study of 130,411 migraineurs and 130,411 age-, sex-, and health plan-matched nonmigraineurs who were members of UnitedHealthcare during 1995 through 1999. The data source for this study was Ingenix's research database containing pharmacy and medical claims for UnitedHealthcare members, and the National Death Index.


METHODS
Incidence of cardiovascular and cerebrovascular events and mortality.


RESULTS
Migraineurs and nonmigraineurs had identical rates of myocardial infarction: 1.4 per 1000 person-years. Migraineurs were 67% more likely to suffer a stroke than nonmigraineurs (adjusted relative risk [RR] 1.67, 95% confidence interval [CI] 1.31-2.13), and had higher rates of unstable angina and transient ischemic attacks. There was no increase in risk of myocardial infarction with current (adjusted RR 0.80, 95% CI 0.58-1.11) or recent (adjusted RR 1.15, 95% CI 0.71-1.87) triptan use. Neither current (adjusted RR 0.90, 95% CI 0.64-1.26) nor recent (adjusted RR 0.84, 95% CI 0.46-1.55) triptan use was associated with risk of stroke. Current users of ergot alkaloids were somewhat more likely to have a stroke than other migraineurs (adjusted RR 1.49, 95% CI 0.93-2.41), but there was no dose-response relationship.


CONCLUSIONS
Use of triptans is not associated with increased risk of any ischemic events, including myocardial infarction and stroke, or mortality. Consistent with previous studies, migraineurs in general have an elevated risk of stroke, but not myocardial infarction, compared with nonmigraineurs.
Velentgas
Priscilla
P
Ingenix Epidemiology, Auburndale, MA 02466, USA.
Cole
J Alexander
JA
Mo
Jingping
J
Sikes
Carolyn R
CR
Walker
Alexander M
AM
D000328:Adult; D015331:Cohort Studies; D004876:Ergot Alkaloids / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy*; D009203:Myocardial Infarction / Q000139:chemically induced; D012189:Retrospective Studies; D012307:Risk Factors; D017366:Serotonin Receptor Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D020521:Stroke / Q000139:chemically induced
D004876:Ergot Alkaloids; D017366:Serotonin Receptor Agonists