ESOC 2026 | The potential vascular risks associated with triptans for the treatment of migraine
Anders Hougaard, MD, PhD, Copenhagen University Hospital, Copenhagen, Denmark, discusses the potential vascular risks associated with the use of triptans for the treatment of migraine. Dr Hougaard highlights that the benefits of triptans should be weighed against this potential risk, and they should not be seen as absolutely contraindicated. This interview took place at the 78th American Academy of Neurology (AAN) Annual Meeting in Chicago, IL.
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Transcript
So triptans have been available for acute migraine treatment for the past three decades and before triptans we had ergotamine which is a drug that is known for its vasoconstrictive properties and possibly due to this relation, since triptans were developed based on the serotonin agonism effects known from ergotamine, there are some concerns that triptans also may cause vasoconstriction and ischemic events...
So triptans have been available for acute migraine treatment for the past three decades and before triptans we had ergotamine which is a drug that is known for its vasoconstrictive properties and possibly due to this relation, since triptans were developed based on the serotonin agonism effects known from ergotamine, there are some concerns that triptans also may cause vasoconstriction and ischemic events. So because of all this, since the introduction of triptans, triptans have been contraindicated in migraine patients with a history of stroke or myocardial infarction and with vascular risk factors. Despite this concern, a direct relation between triptan use and increased stroke risk has never been demonstrated. So there are numerous clinical trials and registry-based data on the relation between triptans and stroke risk in migraine patients not showing an increased risk. But some recent developments have been made here also. There are new studies actually showing for the first time that there may be an increased risk with triptan use in migraine patients. But reassuringly this risk is very low and it is only seen in patients who are at a high baseline risk. So that is patients of older age with a previous history of stroke, myocardial infarction, hypertension. In those people, triptans should be prescribed with caution, but they should not be seen as absolutely contraindicated. So what we currently recommend is that the benefits of the triptans should be taken into account. So in a patient whose quality of life depends on the use of triptans for acute migraine treatment, this potential and small risk of inducing a vascular event associated with triptans should be taken into account. So bottom line is that triptans may have a small associated risk of vascular events, but triptans should not be seen as absolutely contraindicated, even in patients with a previous history of stroke or myocardial infarction.
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