A GROUNDBREAKING study has revealed triptans are the most effective medicine for adults experiencing acute migraines – specifically, eletriptan, rizatriptan, sumatriptan, and zolmitriptan.
Researchers conducted a systematic review and network meta-analysis comparing oral monotherapies for acute migraine treatment in adults. Data from major clinical trial databases and regulatory websites, such as ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform, were collected until June 2023. The review included 137 randomised controlled trials, comprising 89,445 participants with a diagnosis of migraine according to the International Classification of Headache Disorders, and 17 active drug interventions. The study was designed with input from an international panel of clinicians and migraine patients, ensuring relevance to clinical practice.
The analysis revealed that all active interventions were more effective than placebo in achieving pain freedom at two hours, with eletriptan being the most effective, followed by rizatriptan, sumatriptan, and zolmitriptan. Eletriptan also performed best in sustaining pain relief for 24 hours, alongside ibuprofen. Sensitivity analyses on Food and Drug Administration licensed doses only, high versus low doses, risk of bias, and moderate to severe headache at baseline, validated the robustness of these findings. The evidence quality, as assessed by the confidence in network meta-analysis (CINeMA) tool, ranged from high to very low depending on the drug and outcome measured.
The findings suggest that eletriptan, rizatriptan, sumatriptan, and zolmitriptan should be considered the preferred options for acute migraine treatment, especially in clinical practice. Future research should focus on cost-effectiveness and addressing concerns in patients with cardiovascular risks. The inclusion of the most effective triptans in the WHO List of Essential Medicines could ensure broader global access to these highly effective treatments, promoting uniform standards of care.
Katrina Thornber, EMJ
Reference
William K Karlsson et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis. BMJ. 2024;386:e080107.
