Acute Migraine Treatments: Triptans, Ergots, and Antiemetics Most Effective

Certain classes of migraine medications, including triptans, ergots, and antiemetics, are found to be the most effective acute migraine treatments, according to study findings published in Neurology.

Although multiple research studies have explored the effectiveness of migraine medications, there is lack of data on head-to-head comparisons of these treatments based on patient reports.  

Therefore, researchers of a retrospective analysis aimed to study the effectiveness of migraine medications, using records retrieved from a smartphone headache diary application.

Participants used the smartphone app MigraineBuddy™ to monitor migraine symptoms and medication effectiveness. Only those who reported more than 1 migraine episode were eligible for study inclusion.

The primary outcome measure was treatment effectiveness for migraine, as reported by patients. Treatment outcomes were rated as “helpful” (indicated a positive outcome) and “somewhat helpful” and “unhelpful” (indicated negative outcomes).

A total of 278,006 patients who recorded 3,119,517 migraine episodes between 2014 and 2020 were included in the analysis. Of those with available data for age and sex (35.8% and 78.9%, respectively), 90.7% were women and the mean ages of men and women were 37.8 and 35.9, respectively.

Data extracted from the app showed that ibuprofen was the most commonly used medication (usage count, 682,539), with the majority of migraine episodes (65.5%) treated with 1 medication.

On comparing patient-reported treatment effectiveness, triptans vs ibuprofen (reference drug) had the highest effectiveness among the migraine medications (mean odds ratio [OR], 4.8). Of the triptans, eletriptan was found to be the most “helpful” to patients (OR, 6.1; 95% CI, 6.0-6.3; P <.0001), followed by zolmitriptan and sumatriptan.

Ergots and antiemetics were also reported by patient to be highly effective for their migraine episodes (ORs, 3.02 and 2.67, respectively). On the other hand, acetaminophen was considered the least “helpful” medication (OR, 0.83; 95% CI, 0.83-0.84; P <.0001).

A subgroup analysis showed the consistency of these results across different countries.

“Our big data analysis based on patient-generated health data supports and complements the treatment recommendations from national headache societies based on RCTs and meta-analyses,” the researchers concluded. “We also demonstrate how leveraging real-world patient-reported outcomes through an electronic diary could provide important insights to patients and clinicians.”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the authors’ disclosures.