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Migraine league table:

acute treatments and two hour pain free

There are a number of treatments available for acute migraine. This page summarises their efficacy in several ways. The information is drawn predominantly from systematic reviews of comparable trials. The important points that make the treatments comparable are as follows:

So what we have here is a consistent data set. We can tell it is consistent by examining the placebo responses for the treatments - they are all about 8%.


Dangers of over-interpretation

Information from league tables is sometimes over-interpreted. It should not be used to exclude treatments from formularies, for instance. rather we should celebrate the fact that we have so many effective remedies. Some arguments against over-interpretation follow:

Patient choice, and professional choice, will be influenced by many factors. Analgesic efficacy is only one. Moreover, relative efficacy should be used as a tool to guide personal and professional choice, and not be used as a rule to exclude certain types of treatment because of cost or convenience.

So please use the league table as you would a walking stick. Use it to help you and not to beat others.


Information provided

The information here has been collected from reviews. The table gives all the information we thought relevant, including the number of trials and patients from which the table is drawn. The two figures show the results graphically for NNTs, and for the proportion of patients with pain free at two hours. In the figures subcutaneous treatments are in red , and intranasal treatments in green ; all other treatments are oral, with oral treatments that are not triptans in yellow.


Table of relative efficacy of acute migraine treatments - pain free at two hours

Treatment

Placebo

Treatment

Route

Number of trials

Number/Total

Percent

Number/Total

Percent

NNT (95% CI)

Sumatriptan 6 mg Subcutaneous

6

206/345

60

41/338

12

2.1 (1.9 to 2.4)

Rizatriptan 10 mg Oral

7

720/1783

40

83/987

8

3.1 (2.9 to 3.5)

Eletriptan 80 mg Oral

6

386/1221

32

38/779

5

3.7 (3.2 to 4.2)

Zolmitriptan 5 mg Oral

4

298/943

32

17/285

6

3.9 (3.4 to 4.6)

Eletriptan 40 mg Oral

6

335/1224

27

38/779

5

4.5 (3.9 to 5.1)

Sumatriptan 20 mg Intranasal

3

182/536

34

33/276

12

4.6 (3.6 to 6.1)

Sumatriptan 100 mg Oral

8

415/1461

28

53/744

7

4.7 (4.1 to 5.5)

Rizatriptan 5 mg Oral

4

284/933

30

65/713

9

4.7 (4.0 to 5.7)

Zolmitriptan 2.5 mg Oral

2

109/438

25

17/213

8

5.9 (4.5 to 8.7)

Sumatriptan 50 mg Oral

4

131/711

18

21/372

6

7.8 (6.1 to 11)

Aspirin 900 mg + metoclopramide 10 mg Oral

3

69/378

18

25/375

7

8.6 (6.2 to 14)

Naratriptan 2.5 mg Oral

1

44/213

21

9/107

8

8.2 (5.1 to 21)

Eletriptan 20 mg Oral

2

53/349

15

17/353

5

10 (7 to 17)

 


Figure 1: Numbers needed to treat for two hour pain free for each treatment compared with placebo (bars are 95% confidence interval of the NNT)

Figure 2: Percentage of patients with two hour pain free for each treatment (bars are 95% confidence interval of the percentage)