CLINICAL QUESTION

Which type of treatment has a greater chance of relieving pain in patients with acute migraine?

BOTTOM LINE

On average, triptans, such as sumatriptan and eletriptan, are most likely to produce immediate relief of migraine pain and not require subsequent rescue medication. (Level of Evidence = 1a)

SYNOPSIS

The investigators searched three databases, clinical trial registries, regulatory agencies, and pharmaceutical company websites, to identify 137 randomized controlled trials that included 89,445 adults who were treated for acute migraine. They excluded studies with patients who presented to an emergency department. Two researchers independently selected studies and extracted the data. They also identified unpublished data for 67% of the studies. The authors were able to perform a network meta-analysis of 17 medicines, ranging from analgesics to triptans. Using sumatriptan as the standard, only eletriptan produced average greater pain relief at 2 hours and decreased the use of rescue drugs in the first 2 to 24 hours. Triptans are more effective than newer treatments, including ubrogepant (Ubrelvy), lasmiditan (Reyvow), and rimegepant (Nurtec ODT), and analgesics, such as ibuprofen.