OBJECTIVES: At population level, migraine is among the world’s most disabling disorders in terms of years lost to disability. In Europe, triptans are recommended for treatment of migraine when NSAIDs are insufficient but, for some, triptans are also inadequate. In this population-based RWE study, we examined labour-market affiliation of triptan discontinuers (TDs) compared to triptan responders (TRs).

METHODS: From the Danish National Prescription Register we defined TDs as patients (≥18 years) who had redeemed prescriptions for at least three distinct triptans, but fewer than ten for the last prescribed triptan, between 1998 and 2019. Each TD was matched, when possible, by year of birth, declared gender, region of residence and year of first triptan prescription redemption, in a 1:3 ratio with TRs defined as patients with more than ten prescriptions and ongoing redemptions. Labour-market affiliation was analyzed as relative risk of disability pension, and as difference in long-term sick leave (>4 weeks) and unemployment (receipt of social benefits).

RESULTS: TDs had a significantly higher risk of disability pension than TRs (hazard ratio [95% CI] = 1.72 [1.54–1.96]). During the first three years after triptan discontinuation, significantly more TDs were on long-term sick leave than were TRs (p<0.001). Throughout the study period, significantly more TDs were unemployed than were TRs (p<0.001), with ≥25% of TDs being unemployed at some point during each of the first five years after triptan discontinuation.

CONCLUSIONS: Triptan discontinuation was assumed to be due to inadequate response, which is supported by the findings. TDs had significantly higher risks of exclusion from the labour market than their matched TRs. Our findings highlight the impact of inadequately treated migraine on both society and affected individuals and indicate an important and unmet need for further treatment options to recover these losses.