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Migraines are one of the leading causes of disability worldwide, affecting over one billion people. For those suffering from migraines, finding the most effective acute treatment is crucial. A new analysis sheds light on which drugs work best for immediate pain relief during migraine episodes.
The study involved 137 randomized controlled trials and included over 89,000 participants. It compared 17 licensed drug interventions for the acute management of migraines. The findings reveal that certain drugs outperform others, with eletriptan emerging as the most effective treatment for pain freedom within two hours after the dose.
“Eletriptan, sumatriptan, and rizatriptan demonstrated superior efficacy when compared to other treatments,” explains Andrea Cipriani, one of the study authors. He emphasized the importance of these findings, especially for individuals who need rapid and sustained relief from migraine pain.
Migraine treatments often begin with non-steroidal anti-inflammatory drugs (NSAIDs), but in moderate to severe cases, triptans are recommended. This study confirmed that triptans, particularly eletriptan, should be considered the first line of defense in acute migraine management.
“While newer medications like lasmiditan and gepants have been introduced, they don’t outperform the established triptans,” adds Cipriani. “The cost-effectiveness of these newer drugs compared to older options remains questionable.”
The study also highlights that migraine treatments are underutilized globally. “Triptans, despite their proven effectiveness, are not widely accessible,” states Christina Deligianni, another study contributor. The researchers suggest that triptans, especially eletriptan, should be included in the WHO’s List of Essential Medicines to promote accessibility and ensure uniform care standards worldwide.
For sustained pain relief up to 24 hours, eletriptan and ibuprofen performed best. However, the findings also emphasize that cost-effectiveness analyses are needed before widespread implementation of these treatments.
“Clinicians should consider not just efficacy but also the cardiovascular profile of patients when prescribing these drugs,” Deligianni advises, highlighting the potential risks for individuals with underlying heart conditions.
While this study focused on pain relief and efficacy, the researchers also looked into safety profiles. They found that eletriptan and similar triptans are relatively well-tolerated, with fewer side effects compared to some newer migraine treatments.
By comparing the vast array of available treatments, this research provides essential insights for both patients and healthcare providers. It makes a strong case for prioritizing triptans, particularly eletriptan, as the most effective treatment for migraines.
“This information should guide international treatment guidelines to ensure that patients everywhere have access to the best possible care,” concludes Cipriani.
The study is a call to action for global health organizations to ensure that effective migraine treatments like triptans are made more accessible. As millions of people continue to suffer from migraines, optimizing treatment availability and guidelines remains an urgent priority.
More information: Karlsson WK, Ostinelli EG, Zhuang ZA, 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. doi:10.1136/bmj-2024-080107
Journal information: The BMJ
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