Cardiac risk factors and the use of triptans: A survey study

Objective.-To describe current practice in triptan use. Background.-Triptans are effective migraine treatments that cause chest sym ptoms in some patients. True cardiac ischemia is rare. Design.-Headache specialists and family practitioners completed questionnai res regarding the times when triptans are contraindicated, obtaining electr ocardiograms (ECGs), and giving the first dose in the office. Results.-Sixty-five headache specialists and 67 family practitioners respon ded. Headache specialists saw an average of 36.3 patients with headache per week. Family practitioners saw an average of 7.2. Family practitioners and headac he specialists had similar opinions regarding the age at which triptans wer e contraindicated with various numbers of risk factors. Sixty-one percent o f headache specialists and 50% of family practitioners would not use a trip tan at any age for patients with more than three risk factors (P=NS). Ten p ercent of headache specialists obtained an ECG for all patients being presc ribed triptans, while no family practitioners did (P=.008). Ten percent of both family practitioners and headache specialists never obtained an EGG, e ven with multiple cardiac risk factors. Headache specialists obtained ECGs more often than family practitioners (P<.002 for one to three risk factors) . Family practitioners were more likely to give the first dose of the tript an in the office regardless of cardiovascular risk (58% versus 20%, P<.001) . Forty-five percent of headache specialists and 2% of family practitioners never gave the first dose in the office (P<.001). Family practitioners gav e the first dose in the office more readily than headache specialists in pa tients with no risk factors (P=.001), but not for one or more risk factors. Conclusions.-No consensus exists among family practitioners or headache spe cialists about when to avoid using a triptan due to excessive cardiac risk factors, when to obtain an ECG prior to using a triptan, and when to give t he first dose of a triptan in the office. Headache specialists are more lik ely to obtain ECGs, whereas family practitioners are more likely to give th e first dose of a triptan in the office.