Reevaluating triptan contraindications: A follow-up survey among Latin American neurologists

Abstract

ObjectiveSurvey Latin American (LATAM) neurologists on their comfort with prescribing triptans in the setting of common contraindications. BackgroundTriptans are associated with multiple contraindications due to 5-HT1B-mediated vasoconstriction. A previous survey study examined the comfort level of headache specialists from the American Headache Society (AHS) in prescribing triptans in the setting of various contraindications, but this has not been studied in LATAM countries. MethodsWe sent a modified and translated survey to LATAM neurologists with headache management expertise grouped in the Latin American Headache Association (ASOLAC). The survey was extended to local Neurology Associations to increase the sample. An eleventh question on selective serotonin reuptake inhibitors (SSRI) use was added to the original 10 questions. Responses were assessed with descriptive statistics. ResultsThere were 225 surveys analyzed from 10 LATAM countries. Notable results include that 54.2% (122/225) never use triptans in the setting of stroke, 60.9% (137/225) said never for dissection, and 70.2% (158/225) said never for reversible cerebral vasoconstriction syndrome (RCVS), but for venous thromboembolism responses were sometimes in 26.7% (60/225), rarely in 20.9% (47/225), and never in 31.6% (71/225). 57.8% (130/225) responded never for hemiplegic migraine but prolonged aura responses were 25.3% (57/225) sometimes, 25.3% (58/225) rarely, and 40.4% (91/225) never. Responses for use with aneurysms included 23.6% (53/225) sometimes, 15.6% (25/225) rarely, and 44.0% (99/225) never. For poorly controlled hypertension, 58.2% (131/225) said never. For pregnancy, 57.3% (129/225) reported never. Responses for age over 65 years included 35.6% (80/225) sometimes, 32.0% (72/225) rarely, and 22.2% (50/225) never. For SSRI use, responses were 22.7% (51/225) frequently, 38.7% (87/225) sometimes, and 24.0% (54/225) rarely. ConclusionTriptan contraindications were often considered absolute for RCVS, stroke, dissection, hemiplegic migraine, hypertension, and pregnancy. More studies are needed to clarify the true danger of triptan contraindications.