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Oral naratriptan for acute migraine

Clinical bottom line:

Oral naratriptan 2.5 mg has been fully tested in two randomised trials with about 550 patients. The NNT for two hour headache response was 5.4 (3.8 to 9.2). Two hour pain free was available in only one trial with 320 patients, and the NNT was 8.2 (5 to 21). There was no information for sustained outcomes.


Reference


AD Oldman, LA Smith, HJ McQuay, RA Moore. A systematic review of treatments for acute migraine. Pain 2002 97: 247-257.

Inclusion criteria were: treatment of acute migraine; randomised allocation to treatment groups; double-blind design; adult population and headache outcomes.

Search

Comprehensive searches of the following databases were made: MEDLINE (1966 - July 2001), EMBASE (1980 - June 2001), Cochrane Library (Issue 3, 2001), PubMed (to September 2001) and the Oxford Pain Relief Database (1950 - 1994). A series of free text searches were undertaken, using generic and trade names. There was no restriction to language. Retrieved reports were searched for additional trials. Neither individual authors nor pharmaceutical companies were contacted for unpublished data.

Findings

Tables with all included trials and excluded trials are available. The results for the two trials of oral naratriptan 2.5 mg are shown in Table 1.

Table 1: Headache response at two hours with oral naratriptan 2.5 mg

Number/total with outcome (%)

Outcome

Number of trials

Treatment

Placebo

NNT
(95%CI)

Two hour headache response

2

154/340
(45)

61/229
(27)

5.4 (3.8 to 9.2)

Two hour pain free

1

44/213
(21)

9/107
(8)

8.2 (5.1 to 21)

Headache response at 2 hours sustained to 24 hours

no data

 

For oral naratriptan 2.5 mg, 154/340 patients (45%) had a headache response at two hours compared with 61/229 (27%) with placebo. The NNT was 5.4 (3.8 to 9.2).

Adverse effects

Adverse effects are not reported in any way that makes obvious sense because efficacy was measured over 24 hours and adverse events for up to 10 days.

Comment

Naratriptan outcomes were directed towards four hours after tablets were taken. This has little relevance, and has been ignored in this review.