New Migraine Drugs do not Work as Well as Triptans. 2024
Sadly, the new migraine treatment drugs do not work as well as triptans.
Triptans came along in 1990 with the introduction of 6 mg subcutaneously delivered sumatriptan, which the American Academy of Neurology has also concluded is the best drug. As time went on 7 oral drugs, one injectable-sumatriptan, and 2 nasal spray delivery systems, sumatriptan and zomatriptan were developed.
Read my article “What is Migraine?” on my blog, www.doctormigraine.com
The fastest drug delivery was sc sumatriptan, with nasal spray sumatriptan and zomatriptan second, followed by oral drug delivery.
This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.
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A recent study has found that newer developed acute therapy drugs for migraine do not work as well as the triptans. The new medication drugs for migraine considered for this study are the CGRP inhibitors Nurtec (rimegepant), Ubrelvy (ubrogepant), and Reyvow (lasmiditan)
Read my blog article, “Migraine Medication 2023” on my website, www.doctormigraine.com.
New migraine acute treatment drugs that were excluded.
Trudhesa (dihydroergotamine) has a new mechanism of nasal spray injection of DHE, a drug that has long term salutary migraine effects. Elyxyb (celecoxib) is a NSAID delivered quickly as an oral solution. Qulipta (atogepant) and Zavzpret (zavegepant) came on the market after this reported study was done and these new drugs were excluded from this study.
Who made this declaration?
This was a study by CP Yang, CS Liang, CM Chang, et al, writing on “Comparison of New Pharmacologic Agents With Triptans for Treatment of Migraine. A Systematic Review and Meta-analysis.” in JAMA Network Open 2021. 2021;4(10).
What kind of study was it?
The objective of the study was to compare outcomes associated with the use of lasmiditan, rimegepant, and ubrogepant vs triptans for acute management of migraine headaches.
What were the sources of the data?
The authors studied data sources utilizing blind randomized clinical trials for acute treatments for migraine from the Cochrane Register of Controlled Trials, Embase, and PubMed over a time frame from inception to March 5, 2020.
The analysis included 64 randomized clinical trials with a total of 46,442 patients. The age range of the patients was reported to be 36 to 43 years and 74% to 87% of the population was female.
What was used for comparison of data?
The authors used the odds ratio (OR) for freedom from pain at 2 hours after the dose for data comparison.
What were the results of the study?
“For pain freedom or pain relief at 2 hours after the dose, lasmiditan, rimegepant, and ubrogepant were associated with higher ORs compared with placebo but lower ORs compared with most triptans.”
Benefits of the newer acute migraine treatment drugs studied.
Triptans are good acute treatment options for 60-70 % of migraine patients and can give headache free data at 2 hours with this group. But there is a need for treatment of the remaining 30-40% of migraineurs. The CGRP inhibitors Nurtec (rimegepant), Ubrelvy (ubrogepant), and Reyvow (lasmiditan) are helpful second drugs to try for successful migraine treatment.
Triptans are contraindicated in patients with previous heart disease, cardiovascular or cerebrovascular disease, or uncontrolled hypertension. The new drugs reported here had reduced cardiovascular risks and may offer an effective alternative to triptans.
And, also, all the triptans are now generic and cheaper than the CGRP name brand drugs, Nurtec, Ubrelvy, and Rewvow.
Migraine lament.
Many persons with migraine are not diagnosed by their regular doctor and have never been given a triptan for treatment. They may be given a barbiturate headache medicine like Fiorinal or hydrocodone which may start a run into medication overuse headache.
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Britt Talley Daniel MD