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Abstract Details

Reality or Myth: Serotonin Syndrome in Migraineurs with Triptan Use
General Neurology
S27 - General Neurology: Improving Neurologic Care and the Impact of Therapeutics (1:44 PM-1:55 PM)
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  • The primary objective of this study to determine the incidence of serotonin syndrome in migraineurs treated with triptans with co-prescription of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
  • A Food and Drug Administration (FDA) warning issued in 2006 warns about the risk of serotonin syndrome in the setting of triptans co-prescribed with SSRIs and SNRIs. This co-prescription raises concern about safety in migraineurs who have comorbid depression and anxiety.
We analyzed data of 61,029 patients who presented to University of Washington Medical Center in Seattle from 1/1/1990 to 3/22/2018 with an ICD 9 or ICD 10 diagnosis of migraine and identified concurrent triptan prescription. We sub-analyzed these patients using ICD 9 and ICD 10 codes 333.99 and T50.995A, respectively, as there are no specific codes for serotonin syndrome.
We identified 103 migraineurs with triptan prescription and extrapyramidal disorder. We reviewed these charts to determine the overall incidence of serotonin syndrome within this population group. In our study of migraineurs with triptan use, the incidence of serotonin syndrome that met diagnostic criteria was zero. We did not identify that exposure to either triptan monotherapy or co-prescription of triptans and SSRIs or SNRIs placed patients at risk of serotonin syndrome.
Despite expert opinion cautioning against co-prescription of triptans for acute migraine treatment in patients receiving SSRIs or SNRIs due to the risk of serotonin syndrome, we found no evidence supporting this FDA warning. The proportion of triptan users who were co-prescribed these drugs was 32.8%. We agree with recent suggestions that FDA advisory should be reconsidered, as it causes significant anxiety for migraine patients on SSRIs and SNRIs who benefit from triptans for migraine but are concerned about warnings received via electronic medical record and/or pharmacies.
Authors/Disclosures
Michelle L. Kerr, MD (University of Washington, Child Neurology)
PRESENTER 		No disclosure on file
Daniel Krashin, MD (Seattle VA) Dr. Krashin has nothing to disclose.
Natalia Murinova, MD, FAAN (University Of Washington) Dr. Murinova has nothing to disclose.