We evaluated the impact of the number of triptans trialed on triptan effectiveness, tolerability, and healthcare resource use in the Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) study.

The International Headache Society has recently recommended trial of 3 triptans before concluding non-response to the class.

CaMEO-I was a cross-sectional web-based survey conducted in 2021-2022 in the US, UK, France, Germany, Japan, and Canada. Patients with ICHD-3 migraine were stratified by current use or previous trialing of 1, 2, or ≥3 triptans. Associations between number of triptans trialed and the number of doctor’s visits related to headache symptoms, the proportion of patients reporting freedom from pain within 2 hours of triptan use, and the proportion reporting triptan tolerability issues during use were assessed. Chi-square tests for linear trend were conducted for categorical variables across subgroups defined by number of triptans tried.

Of 4216 respondents who had ever used a triptan, 26% (1103) were current triptan users, 44% (1834) trialed 1, 17% (697) trailed  2, and 14% (582)  trialed ≥3triptans. In the last 6 months of current users or those who trialed  1, 2, or ≥3 triptans, 44.0%, 42.5%, 51.1%, and 57.7% had ≥1 doctor’s visit concerning their headache (P<0.001, Figure 1), respectively. Of 2980 respondents who had previously trialed 1, 2, or ≥3 triptans, the proportion reporting that their last triptan provided freedom from pain within 2 hours more than half the time was 31.6%, 23.2%, and 17.6% (P<0.001), respectively. Of respondents who previously trialed 1, 2, or ≥3 triptans, the proportion reporting any tolerability issues with their last triptan increased from 40.3%, to 54.7%, to 72.2% (P<0.001), respectively.

Trialing multiple triptans is associated with increased number of doctor’s visits and decreased effectiveness and tolerability among patients with migraine.