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Subcutaneous sumatriptan for acute migraine

 

Clinical bottom line:

Subcutaneous sumatriptan 6 mg has been tested in eight randomised trials with about 900 patients. For subcutaneous sumatriptan 6 mg in eight trials, 379/477 patients (79%) had a headache response at two hours compared with 131/461 (28%) with placebo. The NNT was 2.0 (1.8 to 2.2). The NNT for two hour pain free was 2.1 (1.9 to 2.4) in 683 patients in six trials. The NNT for two hour headache response sustained for 24 hours with no additional analgesic was 3.2 (2.4 to 4.8) in 304 patients in two trials.


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 Neither individual authors nor pharmaceutical companies were contacted for unpublished data.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. Results for subcutaneous sumatriptan were consistent between trials, and those for two hour headache response are shown in Figure 1.

Figure 1: Headache response at two hours





Table 1: Results for subcutaneous sumatriptan 6 mg



  Number/total with outcome (%)
Outcome Number of trials Treatment Placebo NNT
(95%CI)
Two hour headache response 8 379/477
(79)
131/461
(28)
2.0 (1.8 to 2.2)
Two hour pain free 6 206/345
(60)
41/338
(12)
2.1 (1.9 to 2.4)
Headache response at 2 hours sustained to 24 hours 2 71/144
(19)
28/160
(18)
3.2 (2.4 to 4.8)

For subcutaneous sumatriptan 6 mg in eight trials, 379/477 patients (79%) had a headache response at two hours compared with 131/461 (28%) with placebo. The NNT was 2.0 (1.8 to 2.2). The NNT for two hour pain free was 2.1 (1.9 to 2.4) in 683 patients in six trials. The NNT for two hour headache response sustained for 24 hours with no additional analgesic was 3.2 (2.4 to 4.8) in 304 patients in two trials.

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


Sumatriptan is clearly effective in the treatment of acute migraine, in several doses and by three routes of administration. There is considerable evidence from large, well-conducted randomised trials, with large numbers of patients.