Most effective migraine drugs revealed by review of trial data

An underused drug appears to be more effective than newer, more expensive medications in treating migraine-related symptoms, according to a comprehensive review of clinical trials.

Although triptans were designed specifically to treat migraines, they are used in less than 22% of migraine cases. exclude Their use, such as cardiovascular disease, suggests that people should consider low-cost triptans as first-line treatment for migraine pain. Andrea Cipriani At Oxford University.

“Putting all the data together and re-emphasizing — especially to primary care physicians — that if someone has migraines and there are no contraindications and they’ve tried (NSAIDs), the evidence base for using a triptan is really pretty strong and it’s not a bad idea,” he said Peter Goldsby Professor at King’s College London, but he was not involved in the review.

Since 1991, triptans (such as sumatriptan and eletriptan) have been gradually approved worldwide and are now available as generic or unbranded drugs. However, case reports suggest that These drugs may cause a heart attack or stroke – Especially for people with pre-existing cardiovascular disease.

To provide alternative treatments, pharmaceutical companies have developed new drugs called ditans and gepants that work in a similar way to triptans but avoid the cardiovascular risks. These drugs (lasmiditan, rimegepant, and ubrogepant) have only been licensed in the past few years and are expensive. For example, Eli Lilly’s registered formulation of lasmiditan, Reyvow, retails for $92.50 per 24-hour tablet, while the generic version of eletriptan retails for about $17.

People can also choose to take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and pain relievers, such as acetaminophen, to manage migraine symptoms.

Although researchers have conducted hundreds of studies investigating the efficacy, safety and side effects of the numerous drugs and drug classes used to treat migraine, there is a lack of research comparing them to one another, Cipriani said. To take advantage of the wealth of existing knowledge, he and his colleagues analyzed 137 double-blind, randomized, controlled trials conducted around the world since 1991.

The trial, which involved 89,445 adults, evaluated 17 oral medications versus placebo or other medications. The research team used criteria recommended by the International Headache Society to judge the effectiveness of the medications, including how well the medications controlled pain within two hours or 24 hours of a typical dose.

Their result The results showed that the most effective drug for relieving pain within two hours was the triptan drug eletriptan, followed by three other triptans: rizatriptan, sumatriptan and zolmitriptan.

Eletriptan and ibuprofen are the most effective drugs for providing sustained pain relief for up to 24 hours.

However, lasmiditan, rimegepant, and ubrogepant are no more effective than acetaminophen and most NSAIDs in relieving clinical migraine symptoms, and they carry a higher risk of side effects, such as nausea. Therefore, these drugs should be considered “third-line options,” Cipriani said.

The findings suggest that using certain triptans to treat migraines may be beneficial for some people. But that doesn’t mean they are the right solution for everyone, the coauthors added. Elena Ruiz de la Torre at the European Migraine and Headache Alliance in Brussels. “Migraine is a very personal disease,” she said.

“You really have to do the best you can for the person in front of you,” Goldsby said. Meta-analyses like this one don’t offer much insight at the individual level, he said. “They tell you about a group, but they’re very blunt instruments for trying to understand what’s going on at the individual level.”