Migraine attacks can be excruciatingly painful, and finding the right medication to manage symptoms is crucial for relief. A recent systematic review and network meta-analysis published in The BMJ compared various oral monotherapy options for treating migraine attacks. The analysis, which included data from 137 randomized controlled trials and nearly 90,000 individuals, found that eletriptan was the most effective medication at eliminating pain after 2 hours, surpassing almost all other active interventions. Additionally, eletriptan and ibuprofen were found to be among the most effective in providing sustained freedom from pain. Comparatively, certain triptans, including eletriptan, rizatriptan, sumatriptan, and zolmitriptan, were shown to be more effective than newer migraine medications like lasmiditan, rimegepant, and ubrogepant.
Researcher Andrea Cipriani noted that existing guidelines may need to be revised to reflect the preference for specific triptans in treating acute migraine attacks. However, it is concerning that despite their effectiveness, triptans are underutilized, with only a small percentage of people with migraines using them. The study findings underscore the importance of educating healthcare professionals and policymakers on optimal patient care for migraine sufferers. As migraine affects around 10% of the global population, having effective treatment options is essential, and studies like this can help guide future treatment recommendations and discussions between patients and healthcare providers.
While triptans are considered a recommended treatment for migraines, with the National Institute of Neurological Disorders and Stroke identifying them as the preferred option for moderate-to-severe pain relief, the review also highlighted the potential side effects of these medications. For example, eletriptan was associated with chest pain, and researchers noted that triptans may not be safe for individuals with certain contraindications. Additionally, the study emphasized the need for further research to reexamine vascular contraindications for triptans, suggesting caution in their use for patients with cardiovascular conditions.
Limitations of the review include the potential missed data due to inclusion and exclusion criteria, as well as biases in some studies sponsored by the pharmaceutical industry. Moreover, the lack of diversity in study cohorts, with mostly female participants from America and Europe, calls for more inclusive research in the future. The certainty of evidence varied from high to very low in the reviewed studies, with caution needed in interpreting the results. Despite these limitations, the study highlights the continued effectiveness of certain triptans as viable treatment options for migraine attacks, even amidst newer medications being developed.
