[The Vigimig study of naratriptan use in general practice]. / Etude d'usage du naratriptan en médecine générale "vigimig"

ABSTRACT

INTRODUCTION: Migraine is a prevalent neurological disorder that can be alleviated by specific treatment for acute headaches, in particular, the triptans, including naratriptan. France has developed official guidelines for the use of triptans as part of migraine management. This pharmacoepidemiological study sought to evaluate how naratriptan is prescribed and used in community medicine in France. METHODS: The protocol called for general practitioners to be randomly selected from a list of all physicians in France and for each to include two patients with migraine. Data came from questionnaires completed by the physician and by the patient (including HIT-6 and QVM to assess headache impact and quality of life) as well as a patient diary. RESULTS: In all, 2530 physicians included 3863 patients 54.3% were treated with naratriptan, 22.4% with another triptan and 23.3% with a non-triptan medication. Of the patients receiving naratriptran, 82.3% were women. Migraine impact was greater and quality of life worse in the patients receiving triptans than those treated with other medications (p<0.0001). Naratriptan was prescribed as second-line treatment following failure of an NSAID in 44.2% of patients taking it; 55.3% of them were prescribed a single dose per headache. Overall, initial treatment was taken right at the beginning of the migraine attack in 70.5% of headaches. DISCUSSION: Data from this cross-sectional study indicate that triptans in general and naratriptan in particular are most often prescribed for patients with the most severe migraines. Consistent with official French guidelines, physicians often recommend taking naratriptan after and only if a NSAID fails to provide relief. Nonetheless, one patient in three starts treatment late, which may significantly reduce the efficacy rate, increase the risk of recurrence and side effects, and prolong the headache. CONCLUSION: Naratriptan is generally prescribed in accordance with official guidelines. Delay in taking medication by around one third of patients probably reduces its efficacy.