Treatments of Migraine with Triptans in Individuals with Elevated Cardiovascular Risk and in Pregnant Women

NCT ID: NCT05854992

Last Updated: 2024-12-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

68419 participants

Study Classification

OBSERVATIONAL

Study Start Date

2022-07-05

Study Completion Date

2024-11-01

Brief Summary

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Researchers are evaluating the safety of triptan treatment of migraine in individuals with elevated cardiovascular risk and in pregnant women.

Detailed Description

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Migraine is a very common condition that can be associated with significant morbidity. For the acute treatment of migraine attacks, the use of triptans, NSAIDs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments are associated with improved pain and function. The effectiveness of these therapies has been documented in various studies and summarized in systematic reviews. However, systematic reviews have demonstrated evidence gaps in two groups of patients that were excluded from treatment trials. These are patients with cardiovascular disease or at high risk of cardiovascular events, and pregnant women.

Triptans, the mainstay treatment for migraine attacks and the one supported by the highest quality evidence, are considered vasoactive and are contraindicated per formulary in individuals who have a history of myocardial infarction, stroke, or uncontrolled vascular risk factors such as hypertension. These individuals are usually excluded from randomized trials. Similarly, pregnant women have been excluded from triptans trials and the observational studies offered low certainty evidence about their safety. Yet, 44% of surveyed members of the American Headache Society reported being somewhat or very comfortable using triptans in pregnancy.

Therefore, the investigators intend to evaluate the safety of triptan treatment of migraine in individuals with cardiovascular disease or multiple cardiovascular risk factors, and in pregnant women in two target trial emulations.

Conditions

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Migraine Cardiovascular Diseases Pregnancy

Study Design

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Observational Model Type

OTHER

Study Time Perspective

RETROSPECTIVE

Study Groups

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Cardiovascular Risk Group Treated with Triptans

Subjects with diagnosis of migraine and cardiovascular disease, cerebrovascular disease and/or two or more cardiovascular risk factors who received Triptans as part of clinical care.

Acute migraine treatment with any prescribed triptans

Intervention Type DRUG

Sumatriptan, treximet (sumatriptan/naproxen combination), zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan. No restriction on dose, frequency, duration, or delivery routes.

Cardiovascular Risk Control Group Treated with No Triptans

Subjects with who did not received Triptans as part of clinical care.

Standard of care management of acute migraine without triptans

Intervention Type DRUG

Any standard of care management without triptans

Pregnant Women Group Treated with Triptans

Subjects diagnosed with migraine that received Triptans as part of clinical care during pregnancy.

Acute migraine treatment with any prescribed triptans

Intervention Type DRUG

Sumatriptan, treximet (sumatriptan/naproxen combination), zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan. No restriction on dose, frequency, duration, or delivery routes.

Pregnant Women Control Group Treated with No Triptans

Subjects that did not receive Triptans as part of clinical care during pregnancy.

Standard of care management of acute migraine without triptans

Intervention Type DRUG

Any standard of care management without triptans

Interventions

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Acute migraine treatment with any prescribed triptans

Sumatriptan, treximet (sumatriptan/naproxen combination), zolmitriptan, naratriptan, rizatriptan, almotriptan, eletriptan, and frovatriptan. No restriction on dose, frequency, duration, or delivery routes.

Intervention Type DRUG

Standard of care management of acute migraine without triptans

Any standard of care management without triptans

Intervention Type DRUG

Other Intervention Names

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Triptans No triptans

Eligibility Criteria

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Inclusion Criteria

* Aged \>=18 years
* At least 1 year history of migraine with or without aura
* Confirmed cardiovascular or cerebrovascular disease, including myocardial infarction (MI), coronary artery disease (CAD), cerebrovascular disease, stroke; or at least 2 cardiovascular risk factors, including diabetes, hyperlipidemia, hypertension, obstructive sleep apnea, peripheral vascular disease;
* At least 1 year of prior triptan treatment or no previous triptan treatment.

Exclusion:

• Prescription of ergot alkaloids or dihydroergotamine within 60 days before or after starting treatment

Treatments of Migraine With Triptans in Pregnant Women

Inclusion:

* Aged \>=18 years
* Pregnant woman
* Diagnosis of episodic or chronic migraine with or without aura before pregnancy

Exclusion:

• Prescription of ergot alkaloids or dihydroergotamine \<= 60 days before pregnancy or during pregnancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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M. Hassan Murad, M.D.

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mohammad Murad, MD

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

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Mayo Clinic Arizona

Phoenix, Arizona, United States

Site Status

Mayo Clinic Florida

Jacksonville, Florida, United States

Site Status

Mayo Clinic Minnesota

Rochester, Minnesota, United States

Site Status

Countries

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United States

References

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Wang Z, VanderPluym JH, Halker Singh RB, Alsibai RA, Roellinger DL, Murad MH. Safety of Triptans in Treating Migraines in Pregnant Women: A Target Trial Emulation. Mayo Clin Proc. 2025 Jul 28:S0025-6196(25)00105-3. doi: 10.1016/j.mayocp.2025.01.023. Online ahead of print.

Reference Type DERIVED
PMID: 40719668 (View on PubMed)

Wang Z, VanderPluym JH, Halker Singh RB, Alsibai RA, Roellinger DL, Firwana M, Murad MH. Safety of Triptans in Patients Who Have or Are at High Risk for Cardiovascular Disease: A Target Trial Emulation. Mayo Clin Proc. 2024 Nov;99(11):1722-1731. doi: 10.1016/j.mayocp.2024.03.023. Epub 2024 Aug 30.

Reference Type DERIVED
PMID: 39207344 (View on PubMed)

Related Links

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Other Identifiers

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22-005920

Identifier Type: -

Identifier Source: org_study_id