Triptans, ergots, anti-emetics most effective acute migraine treatments
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Key takeaways:
- Researchers analyzed 3,119,517 migraine attacks among 36,840 unique medication entries for 278,006 users.
- Eletriptan, zolmitriptan and sumatriptan were the most effective individual medications.
Among seven classes and 25 individual medications, triptans, ergots and anti-emetics were the most effective acute treatments for individuals with migraine, according to research published in Neurology.
“Migraine affects 1 billion people worldwide and is among the top leading causes of years-lived with disability,” Chia-Chun Chiang, MD, lead study author and assistant professor of neurology at the Mayo Clinic, and colleagues wrote. “Effective acute migraine pharmacological therapies are crucial to reduce functional disability by alleviating symptom severity and decreasing the duration of migraine attacks.”
Chiang and colleagues aimed to compile a list of effective migraine treatments, including ibuprofen, and compare them head-to-head to understand which were the most effective.
Their retrospective study initially yielded 10,842,795 migraine attack records logged on Migraine Buddy, an e-diary smartphone app, between June 30, 2014, and July 2, 2020. The final analysis included 4,777,524 medication-outcome pairs from 3,119,517 migraine attacks among 36,840 unique medication entries for 278,006 users. They examined 25 medications in seven classes: acetaminophen, NSAIDs, triptans, combination analgesics, ergots, anti-emetics and opioids, also combining different doses and formulations of each medication according to generic nomenclature. Two-level nested logistic regression model was employed to analyze the odds ratio of treatment effectiveness for each medication by adjusting concurrence as well as covariance for the same user, with subgroup analyses conducted for those in the United States, the United Kingdom, and Canada.
According to results, triptans (mean OR = 4.8), ergots (mean OR = 3.02) and anti-emetics (mean OR = 2.67) had the highest effectiveness, followed by opioids (mean OR = 2.49), NSAIDs other than ibuprofen (mean OR = 1.94), combination analgesics (acetaminophen/acetylsalicylic acid/caffeine) (OR = 1.69; 95% CI, 1.67-1.71), others (OR = 1.49; 95% CI 1.47-1.5) and acetaminophen (OR = 0.83; 95% CI, 0.83-0.84), using ibuprofen as the reference.
Data further showed the individual medications with the highest ORs were eletriptan, zolmitriptan and sumatriptan, with ORs of acetaminophen, NSAIDS, combination analgesics and opioids mostly around or less than 1, suggesting similar or lower effectiveness compared with ibuprofen. Country-specific subgroup analyses revealed similar ORs of each medication and area under the curve (U.S., 0.849; U.K., 0.864; Canada 0.842).
“For people whose acute migraine medication is not working for them, our hope is that this study shows that there are many alternatives that work for migraine, and we encourage people to talk with their doctors about how to treat this painful and debilitating condition,” Chiang said in a related release.