A migraine diagnosis often brings more than just pain—it can come with difficult treatment decisions, especially for patients with underlying heart risks. But new research suggests that a widely used migraine medication may not be as concerning as once feared.
A large population-based study showed no evidence that triptans—commonly used to treat migraine attacks—increase short-term cardiovascular risk, even among patients with conditions like hypertension, diabetes, and dyslipidemia.
Researchers analyzed data from over 26,000 adults diagnosed with migraine across a 22-year period. Nearly half—12,560 individuals—used triptans at least once. The study assessed whether these people experienced a heart attack or ischemic stroke within 90 days of purchasing a triptan.
Cardiovascular (CV) events occurred among 5.1% of triptan users, compared with 4.1% of non-users. However, after adjusting for age, sex, socioeconomic status, and baseline CV risk factors, this difference was not statistically significant (adjusted hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.77–1.23).
These findings were consistent across multiple sensitivity analyses. Researchers evaluated one- and six-month risk windows, one-time versus repeated use, and various triptan types, but none showed an increased risk of CV events associated with triptan use.
Most triptan users took the medication infrequently. Average monthly use was fewer than two pills, with 89.5% taking between one and four pills. Only 9.2% used 10 or more pills per month.
Among the 33 triptan users who experienced a CV event within 90 days, most had pre-existing risk factors and used the medication more frequently. Their average monthly intake was 2.8 pills, compared with 1.9 pills among those who did not experience an event.
The study included adults aged 18 and older with a documented migraine diagnosis or a prescription for triptans. Data were drawn from electronic medical records over two decades. Patients with a history of major CV disease, such as prior heart attacks or strokes, were typically excluded from triptan use.
Triptans are serotonin receptor agonists used for acute migraine treatment. Although their vasoconstrictive properties previously raised safety concerns, the study showed no increased short-term CV risk in most users.
Additionally, researchers emphasized the importance of individualized treatment decisions. While triptans remain contraindicated for patients with established CV or cerebrovascular disease, they may be suitable for those with controlled risk factors.
This study adds real-world evidence suggesting that triptans can be used safely by most patients with migraine without increasing their short-term risk of heart attack or stroke, when no formal contraindications are present.
Full disclosures can be found in the published study.
Source: Headache
