In a systematic review and network meta-analysis published in The BMJ, researchers compared oral monotherapy treatment options for migraine attacks, analyzing data from 137 randomized controlled trials and almost 90,000 individuals. Overall, eletriptan emerged as the most effective medication for eliminating pain after 2 hours, with rizatriptan, sumatriptan, and zolmitriptan also showing significant effectiveness. Sustained freedom from pain was most notable with eletriptan and ibuprofen. The review indicated that certain triptans, such as eletriptan, rizatriptan, sumatriptan, and zolmitriptan, were more effective than newer migraine medications like lasmiditan, rimegepant, and ubrogepant. This study’s findings suggest a need to update existing treatment guidelines to reflect the preferential use of certain triptans for migraine management.
Triptans are commonly used to treat acute migraine attacks by constricting blood vessels and blocking pain signals. The findings from this review may assist in guiding treatment recommendations for individuals experiencing migraines. The study identified eletriptan, rizatriptan, sumatriptan, and zolmitriptan as the most effective medications for managing acute migraine attacks. Despite their effectiveness, triptans are underused, with only a small percentage of people with migraines utilizing them. It is crucial to inform healthcare professionals and policymakers about the effectiveness of specific triptans to ensure optimal patient care.
The review highlighted the importance of proper dosing and switching triptans when needed, particularly due to the cost implications for many migraine sufferers. It emphasized the potential accessibility of triptans over newer gepant medications for individuals with migraines, especially in underserved areas. Triptans are already recognized as a preferred treatment for migraine, based on current guidelines. However, healthcare providers should be aware of potential side effects such as chest pain associated with certain triptans, and consider individual contraindications before prescribing these medications.
While the study provided valuable insights into the efficacy of different oral monotherapy treatments for migraine, it also had limitations that should be considered. The inclusion and exclusion criteria could have led to missed data or biased results, as only studies with specific requirements were included. The lack of diverse study cohorts, with most participants being female and studies predominantly coming from America and Europe, may impact the generalizability of the findings. The researchers noted various limitations in the individual studies included, such as potential biases due to industry sponsorship.
The analysis assessed the certainty of the evidence, finding it varied from high to very low for most comparisons. The researchers cautioned that confidence in the findings was limited due to bias risk, heterogeneity, and inconsistencies among comparisons. Despite these limitations, the results suggest that certain triptans remain effective treatment options for acute migraine attacks, urging revisions to clinical practice guidelines to reflect the preferential use of specific medications. Further research is needed to address the gaps identified in this study, such as evaluating combination drug therapies and cost-effectiveness, to optimize migraine management strategies for individuals experiencing these debilitating attacks.
