Evolution of use and overuse of triptans in Austria – What has changed in the last 15 years?

Triptans are highly effective acute treatments for migraine attacks, yet population-level data suggest persistent underuse. Updated real-world data on triptan use and overuse in Austria are lacking. This nationwide, retrospective claims-based study analysed triptan use and overuse in Austria in 2023. Adults (≥ 18 years) with at least one dispensed triptan were identified. Triptan overuse was defined as the dispensing of ≥ 30 defined daily doses (DDDs) in at least one quarter, consistent with the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. Data on demographics, preventive migraine therapies, antidepressant use, sick leave, and hospital admissions were assessed and compared with data from 2007 using identical methodology. Among 7.75 million insured adults, 63,729 individuals (0.82%) fulfilled the inclusion criteria and used triptans, representing a 46% increase since 2007. However, this corresponds to an estimated number of approximately 8% of individuals with migraine. Triptan overuse more than doubled compared with 2007 (12.5% vs. 5.9%) and was associated with older age, with the largest proportion of overusers being 51–65 years old. Overusers showed substantially higher use of preventive therapies, including anti-calcitonin-gene-related-peptide (CGRP) antibodies (21.8% vs. 9.7%), and antidepressants (24.8% vs. 19.9%) (all p < 0.001). Hospital admissions were slightly more frequent among overusers, whereas sick-leave days were less frequent in this group. Women were more likely than men to use triptans, anti-CGRP antibodies, and antidepressants. Despite increased triptan use over the past 15 years, overall utilization in Austria remains low, while the percentage of patients with triptan overuse has more than doubled. Preventive migraine therapies remain infrequently prescribed. Higher rates of hospital admissions and concomitant antidepressant use may indicate a greater overall disease burden among triptan overusers.