Aims: Migraines are one of the most common neurological disorders that patients typically suffer from. One of the more common prescription medications for migraines are triptans, which can lead to vasoconstriction throughout the peripheral vasculature as a potential side effect. However, a possible risk of femoral avascular necrosis may arise from these treatments, as it has been well known that a lack of blood flow to the femur can arise due to this peripheral vasoconstriction. Therefore, research is warranted for whether taking anti-migraine medications is associated with a higher risk of developing avascular necrosis within the femur, an area highly susceptible to ischemia.
Methods: A retrospective TriNetX database analysis was performed. The first cohort were patients aged 18-50 from the TriNetX database who had migraines and were on at least one triptan medication. The second cohort was defined as all patients from the TriNetX database who had migraines but were not prescribed these medications. Similar cohorts were made but split on the basis of sex. Propensity matching was computed for the most common causes of femoral avascular necrosis. The relative risk and odds ratio for outcomes of femoral avascular necrosis were compared between the two cohorts.
Results: Findings demonstrated that in the generalized cohorts, male only cohorts, and female cohorts, there was no statistically significant difference between avascular necrosis outcomes between migraine patients. The generalized triptan group had a risk ratio and odds ratio of 0.968 (95% CI: 0.884,1.060) for developing avascular necrosis of the femur, compared to the non-triptan group. The male triptan cohort had a risk ratio of 0.950 (95% CI: 0.792,1.139) and an odds ratio of 0.949 (95% CI: 0.791,1.139), for developing avascular necrosis of the femur, compared to the male non-triptan cohort. The female triptan cohort had a risk ratio of 1.002 (95% CI: 0.900, 1.115) and an odds ratio of 1.002 (95% CI: 0.899, 1.115) for developing avascular necrosis of the femur, compared to the female non-triptan cohort.
Conclusion: The results suggest that there is relatively no increased risk in femoral avascular necrosis amongst migraine patients with the use of triptans. The findings of this study provide reassurance regarding the femoral avascular necrosis risk profile of triptans, though small effects cannot be excluded.