Patterns of migraine medication use in Norway: A nationwide registry-based observational study.

OBJECTIVE: The objective of this study was to describe and discuss patterns of migraine medication use in the entire Norwegian population. METHODS: In this nationwide, observational study, all individuals with a migraine-related prescription between 2010 and 2020 were identified using the Norwegian Prescription Database. The outcomes of interest were the incidence and 1-year prevalence of migraine medication users, as well as individuals with triptan overuse. Patterns of medication use were statistically compared between women and men adjusted for age, year of treatment start, comorbidities and county of residence calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: We identified 327,904 migraine medication users. The incidence ranged from 0.39% to 0.46%, and the 1-year prevalence increased from 1.99% to 2.99%. Preventive use increased >50% during the study period. Preventives were significantly more often prescribed to women than to men (39.72% vs. 33.75%; aOR 1.41, 95% CI 1.38 to 1.44). Triptan overuse was significantly more common among women, but women with overuse were more often using preventives, as compared to men (56.64% vs 52.69%; aOR = 1.43, 95% CI 1.37 to 1.49). CONCLUSION: The prevalence of medically treated migraine is low. Overuse of triptans is frequent, especially among women. Clinicians should be encouraged to try out different triptans, recognize triptan overuse, and prescribe preventives when indicated.

Comparative retention and effectiveness of migraine preventive treatments: A nationwide registry-based cohort study.

BACKGROUND AND PURPOSE: Little is known about the comparative effects of migraine preventive drugs. We aimed to estimate treatment retention and effectiveness of migraine preventive drugs in a nationwide registry-based cohort study in Norway between 2010 and 2020. METHODS: We assessed retention, defined as the number of uninterrupted treatment days, and effectiveness, defined as the reduction in filled triptan prescriptions during four 90-day periods after the first preventive prescription, compared to a 90-day baseline period. We compared retention and efficacy for different drugs against beta blockers. Comparative retention was estimated with hazard ratios (HRs), adjusted for covariates, using Cox regression, and effectiveness as odds ratios (ORs) using logistic regression, with propensity-weighted adjustment for covariates. RESULTS: We identified 104,072 migraine patients, 81,890 of whom were female (78.69%) and whose mean (standard deviation) age was 44.60 (15.61) years. Compared to beta blockers, botulinum toxin (HR 0.43, 95% confidence interval [CI] 0.42-0.44) and calcitonin gene-related peptide pathway antibodies (CGRPabs; HR 0.63, 95% CI 0.59-0.66) were the least likely to be discontinued, while clonidine (HR 2.95, 95% CI 2.88-3.02) and topiramate (HR 1.34, 95% CI 1.31-1.37) were the most likely to be discontinued. Patients on simvastatin, CGRPabs, and amitriptyline were more likely to achieve a clinically significant reduction in triptan use during the first 90 days of treatment, with propensity score-adjusted ORs of 1.28 (95% CI 1.19-1.38), 1.23 (95% CI 0.79-1.90), and 1.13 (95% CI 1.08-1.17), respectively. CONCLUSIONS: We found a favorable effect of CGRPabs, amitriptyline, and simvastatin compared with beta blockers, while topiramate and clonidine were associated with poorer outcomes.

Community matters: Heterogeneous impacts of a sanitation intervention.

Sanitation is at the heart of public health policies in most of the developing world, where around 85% of the population still lack access to safe sanitation. We study the effectiveness of a widely adopted participatory community-level information intervention aimed at improving sanitation. Results from a randomized controlled trial, implemented at scale in rural Nigeria, reveal stark heterogeneity in impacts: the intervention has immediate, strong and lasting effects on sanitation practices in less wealthy communities, realized through increased sanitation investments. In contrast, we find no evidence of impacts among wealthier communities. This suggests that a targeted implementation of CLTS may increase its effectiveness in improving sanitation. Our findings can be replicated in other contexts, using microdata from evaluations of similar interventions.

Sustainable Total Sanitation in Nigeria: implementation, learning, research and influence on practice and policy, formal research component

The main aim of the STS Nigeria project is to eradicate open defecation and improve hygiene practices in households in rural and semi-urban Nigerian communities. By improving sanitation, the program aims to improve the well-being of households in treated communities. WaterAid Nigeria (WANG) is undertaking this project through the Local Government Areas (LGAs) as well as Non-Governmental Organisations (NGOs), in three Nigerian states: Jigawa, Ekiti and Enugu. This study aims to encourage people to use private sanitation solutions and to supply better quality private sanitation solutions that meet the local needs at a more affordable price in rural communities. In order to achieve this, we are implementing two different but closely connected methods: Community-Led Total Sanitation (CLTS), which is a community mobilization intervention, and Sanitation Marketing (SanMark), which targets suppliers of sanitation materials.