Migraine is an inherited, disabling neurologic illness. It is the number one medical problem, affecting 26 % of women. Migraine for women is more frequent than hypertension, osteoarthritis, diabetes, thyroid disease, or heart disease.

Also, migraine is, for many, temporarily disabling, causing missed school and work. The International Classification of Headache states that migraine lasts from 4 to 72 hours. Consider that fact-3 days of nausea, vomiting, and severe headache, being in bed, cancelling all your plans. Migraine is a top reason for presentation to the emergency department.

The use of triptan medications in 1990 changed the course of acute treatment of migraine. Taken at onset of a migraine one of the triptans could give a headache free experience in two hours.

Now there are other drugs for treating migraine, but the new ditan and gepant acute treatment drugs were not used in this study.

Read my article on my website, www.doctormigraine.com MIGRAINE MEDICATION 2023

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.

Read my mini book on Migraine. Click here.

Read my mini book on migraine. Click here

What is this new migraine treatment study?

An article published in Medscape Medical News 5/02/23 by Megan Brooks entitled “Head-to-Head Comparison of 25 Migraine Meds Reveals Top Options.” Ms. Brooks reviewed a study from the American Association of Neurology 2023 annual meeting by investigator Chia-Chun Chiang, MD, neurologist with Mayo Clinic, Rochester, Minnesota. Results from this study follow:

“Despite a wide variety of acute migraine medications that are available, large-scale, head-to-head comparisons of treatment effectiveness from real-world patient experience reports are lacking,” Chiang explained.

"To the best of our knowledge, this is the first study that simultaneously compared multiple acute migraine medications using a Big Data analysis approach based on real-world patient-provided data," she said.

The researchers extracted more than 10 million self-reported migraine attack records from a migraine smartphone app called Migraine Buddy, where users can document whether a treatment was helpful, somewhat helpful, unsure or unhelpful.

They analyzed 25 acute medications among seven classes: acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, combination analgesics (acetaminophen/aspirin/caffeine), ergots, antiemetics, and opioids.

The newer gepants and ditan medication classes of medications were not included because of the relatively lower numbers of usage when data was extracted (2014-2020).

The final analysis included more than 3.1 million migraine attacks among 278,000 users globally.

The studiers used the mean odds ratio to judge the drugs with highest efficacy.

Using ibuprofen as the reference, triptans, ergots, and antiemetics had the highest odds ratio efficacy of 4.8, 3.02 and 2.67, respectively, followed by opioids 2.49, NSAIDs 1.94, combination analgesics 1.69, others 1.49 and acetaminophen,  0.83.

Individual triptanswith the highest patient-reported effectiveness were eletriptan Relpax; 6.1, zolmitriptan Zomig; 5.7 and sumatriptan Zecuity; 5.2.

This migraine medication comparative effectiveness analysis, based on patient-reported outcomes, "supports and complements the treatment recommendations from national headache societies based on randomized controlled trials and meta-analyses and strongly support the use of triptans," Chiang said.

Commenting on this research for Medscape Medical News, Shaheen Lakhan, MD, PhD, a neurologist and researcher in Boston, said "This is a great study of Big Data in that it shows the power of the smartphone to collect real-world data and smart researchers like at Mayo Clinic to analyze them."

"The study sheds light on how different therapeutics compare to each other. The next iteration of this line of research, I would hope, would be to determine if particular medications are effective for a particular migraine population, and even down to individuals with migraine," said Lakhan, who wasn’t involved in the study.

"Once those models are appropriately built, long gone will be the era of trial-and-error medicine and truly personalized healthcare," Lakhan added.

Comment

In the old days it was always said that no one ever knew what was the best triptan to take for migraine acute therapy. There are seven triptan drugs. Pharmaceutical companies paid for the studies and no results were ever obtained. The following is a quote from an article I wrote called “Triptans for Migraine Treatment.”

“This question has never been answered.  Imitrex (sumatriptan) was the first and has always been the most popular drug and it comes in more applications—Sub Cutaneous, 2 forms of Nasal Spray, 3 different sized oral pills, and mixed with naproxen.”

The American Academy of Neurology said years ago that injectable subcutaneous 6 mg sumatriptan was the best of the triptan group of drugs for treating migraine. That was because subcutaneous sumatriptan gave the highest level in the brain-100 mg, versus sumatriptan oral-brain 30 mg.

Subcutaneous sumatriptan worked the fastest-10 minutes, while oral sumatriptan took 30 minutes.The currently reported study only looked at oral medication for migraine.

The big deal about this study is the result of efficacy using different drugs for migraine utilizing smart phones, and a migraine app. The final analysis included more than 3.1 million migraine attacks among 278,000 users globally.

Read my big book on Migraine, second edition. Click here.

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 Britt Talley Daniel MD