title: Utilisation of prescription and over-the-counter triptans: a cross-sectional study in Stockholm, Sweden.
abstract: OBJECTIVE
  Triptans are widely used in acute migraine, and in some countries, they are also available over-the-counter (OTC). In Sweden, sales have increased for both prescription and OTC triptans. This study aimed to describe current prescribing and utilisation patterns of prescription and OTC triptans in Stockholm, Sweden.
  
  
  METHODS
  Register data from 4759 patients dispensed triptans in 2014 were used to study documented diagnosis of migraine, concomitant acute and preventive treatment for migraine, and contraindications. Survey data from 49 patients purchasing OTC triptans in three pharmacies were used to capture physician-diagnosed migraine, concomitant acute and preventive treatment for migraine, a behaviour of combining or alternating between prescription and OTC triptans, and pharmacy counselling rates.
  
  
  RESULTS
  Among the prescription triptan users, 52 % had a recorded diagnosis of migraine, 48 % had no other acute treatment, preventive treatment was rare (12 %) and contraindications were found in 2 % of the patients. Among the OTC triptan users, the majority (63 %) had been diagnosed by a physician and had a history of prescription triptan use, but combining or alternating between OTC and prescription triptans was rare. Concomitant acute treatment was reported in 53 % and preventive treatment was rare (4 %), despite high self-reported migraine frequencies. Some off-label use was detected, despite moderate to high counselling rates.
  
  
  CONCLUSIONS
  Triptans are prescribed with attention to safety but with poor recording of migraine diagnosis. OTC triptan users generally have a history of prescription triptan use. Preventive treatment rates are low in both groups. Strategies to discern patients who need other treatment options should be considered.
authors.affiliation: Department of Pharmaceutical Biosciences, Uppsala university, Box 591, Uppsala, SE-751 24, Sweden. pia.frisk@farmbio.uu.se.|Department of Healthcare development, Public Healthcare Services Committee, Stockholm County Council, Box 6909, Stockholm, SE-102 39, Sweden. pia.frisk@farmbio.uu.se.
authors.forename: Pia
authors.initials: P
authors.lastname: Frisk
authors.affiliation: Department of Pharmacy, Section for Social and Clinical Pharmacy, University of Copenhagen, Universitetsparken 2, Copenhagen, DK-2100, Denmark.
authors.forename: Sofia K
authors.initials: SK
authors.lastname: Sporrong
authors.affiliation: Department of Healthcare development, Public Healthcare Services Committee, Stockholm County Council, Box 6909, Stockholm, SE-102 39, Sweden.|Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Berzelius väg 3, Stockholm, SE-171 77, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ljunggren
authors.affiliation: Department of Healthcare development, Public Healthcare Services Committee, Stockholm County Council, Box 6909, Stockholm, SE-102 39, Sweden.|Clinical Pharmacology and Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Clinical Epidemiology Unit T2, Karolinska University Hospital, Solna, Stockholm, SE-171 76, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
authors.affiliation: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, Stockholm, SE-118 83, Sweden.|Department of Clinical Pharmacology L7:03, Karolinska University Hospital, Solna, SE-171 76, Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: von Euler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002947:Cities; D000075202:Contraindications; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy*; D004366:Nonprescription Drugs; D010594:Pharmacies; D055553:Prescription Drugs; D013548:Sweden; D014363:Tryptamines / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D004366:Nonprescription Drugs; D055553:Prescription Drugs; D014363:Tryptamines
keywords: Drug utilisation; OTC; Over-the-counter; Prescription; Survey; Triptans