The study published in the journal Neurology used data from nearly 300,000 people using a smartphone application to help people make decisions about their medications. Mayo Clinic–led researchers determined that migraine medications such as triptans, ergots, and antiemetics could be two to five times more effective than ibuprofen for treating migraine attacks.
“There are many treatment options available to those with migraine. However, there is a lack of head-to-head comparisons of the effectiveness of these treatment options,” said lead author Chia-Chun Chiang, MD, of the Mayo Clinic in Rochester, Minnesota. “These results confirm that triptans should be considered earlier for treating migraine, rather than reserving their use for severe attacks.”
While many acute treatment options exist for migraine, there have been few large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience reports, according to the authors.
To remedy that, they conducted a retrospective analysis of 10.8 million migraine attack records extracted from an e-diary smartphone application between June 30, 2014, and July 2, 2020. The researchers analyzed 25 acute medications among seven classes—acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, combination analgesics, ergots, antiemetics, and opioids. Gepants and ditans were not included in the analysis, however.
Subgroup analyses of different doses and formulations of each medication were conducted for users in the United States, the United Kingdom, and Canada.
The final analysis included about 4.8 million medication-outcome pairs from about 3.1 million migraine attacks among 278,006 users.
The results indicated that triptans (mean odds ratio [OR] 4.8), ergots (mean OR 3.02), and antiemetics (mean OR 2.67) were the top three classes of medications with the highest effectiveness. Those were 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, 1.47-1.50), and acetaminophen (OR 0.83, 95% CI, 0.83-0.84), using ibuprofen as the reference.
Individual medications with the highest ORs were eletriptan (OR 6.1, 95% CI, 6.0-6.3), zolmitriptan (OR 5.7, 95% CI, 5.6-5.8), and sumatriptan (OR 5.2, 95% CI, 5.2-5.3), according to the study team, which advised, “The ORs of acetaminophen, NSAIDS, combination analgesics and opioids were mostly around or less than 1, suggesting similar or lower reported effectiveness compared to ibuprofen.” The study noted that ORs for 24 medications, except that of acetylsalicylic acid, achieved statistical significance with P <.000.
In essence, the study found that eletriptan was six times more effective than ibuprofen, zolmitriptan was five and a half times more effective, and sumatriptan was five times more effective.
The researchers found that participants using eletriptans found it helpful 78% of the time; zolmitriptan was helpful 74% of the time; sumatriptan was helpful 72% of the time; and ibuprofen was helpful 42% of the time. NSAIDs other than ibuprofen were determined to be 94% more effective than ibuprofen.
In other findings:
• Ketorolac was deemed helpful 62% of the time
• Indomethacin was helpful 57% of the time
• Diclofenac was helpful 56% of the time.
“However, acetaminophen was helpful 37% of the time and found to be 17% less effective than ibuprofen when used for treating migraines,” the authors pointed out. “Additionally, a common combination of medications used to treat migraine, aspirin, acetaminophen and caffeine was also evaluated and found to be 69% more effective than ibuprofen.”
According to the study, it provides class IV evidence that for patients with migraine, selected acute medications (e.g., triptans, ergots, antiemetics) are associated with higher odds of user-rated positive response than ibuprofen.
“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,” Dr. Chiang said in an American Academy of Neurology press release.
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