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Almotriptan for acute migraine

Clinical bottom line

Almotriptan 12.5 mg appears to be an effective treatment for acute migraine, with NNTs of about 4 for headache response, and being pain free at two hours, and with a possible better response than most triptans for sustained pain free outcome. This conclusion is limited by some lack of detail in the analyses.


Systematic review

This was a large systematic review of triptans that included unpublished material as well as published material. Trials had to be randomised and double blind, treating moderate or severe migraine pain, according to HIS diagnostic criteria, within eight hours of onset.

Reference

MD Ferrari et al. Oral triptans (serotonin 5-HT aginists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 2001 358: 1668-1675.
CG Dahlof et al. How does almotriptan compare with other triptans? A review of data from placebo-controlled clinical trials.

Results

Results are presented fort almotriptan 12.5 mg, but not in a manner that allows detailed calculation of NNTs. The number of patients in almotriptan studies was not given.

Headache response at two hours was reported in about 63% of patients, about 25% after subtraction of placebo, with an NNT of about 4.

Pain free at two hours was reported in about 36% of patients, about 22% after subtraction of placebo, with an NNT of 4-5.

Almotriptan appeared to be better than many other triptans for the outcome of sustained pain free, with about 24% of patients having this outcome.

Comment

Almotriptan 12.5 mg appears to be an effective treatment for acute migraine.