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Naratriptan for acute migraine

 

Clinical bottom line

Naratriptan 2.5 mg is better than placebo but less effective than sumatriptan 100 mg and rizatriptan 10 mg for treating acute migraine attacks when measured four hours after the dose.


Reference

DM Ashcroft, D Millson. Naratriptan for the treatment of acute migraine: meta-analysis of randomised controlled trials. Pharmacoepidemiology and Drug safety 2004 13: 73-82.

Background

Naratriptan is a widely prescribed triptan for treating acute migraine attacks. While most studies in acute migraine have concentrated on speedy pain relief, with outcomes at two hours after doing in patients with at least moderate pain, the trials of naratriptan have predominantly measured outcomes at four hours. This tends to make a drug look somewhat better than when outcomes are measured after two hours.

Methods of the review

Results

Comparisons with placebo are shown in Table 1 for all outcomes and for naratriptan 1 mg and 2.5 mg. Lower (better) NNTs were seen with higher dose and with less difficult outcomes like headache response. Results were consistent between trials, as Figure 1 demonstrates for the outcome of headache response at four hours for naratriptan 2.5 mg.

Table 1: Results for different outcomes with naratriptan 1 and 2.5 mg in acute migraine

Number of
Percent with
Outcome
Trials
Patients
Naratriptan
Placebo
NNT
(95%CI)
Naratriptan 1 mg
Headache response 4 hours
3
1938
55
33
4.5
(3.8 to 5.6)
Pain free 4 hours
3
1938
32
16
6.5
(5.3 to 8.6)
Sustained response 4-24 hours
3
1938
35
20
6.8
(5.4 to 9.3)
Naratriptan 2.5 mg
Headache response 4 hours
6
2358
64
31
3.1
(2.7 to 3.5)
Pain free 4 hours
6
2358
41
15
4.0
(3.5 to 4.6)
Sustained response 4-24 hours
6
2358
44
19
3.9
(3.4 to 4.5)

 

Figure 1: Naratriptan 2.5 mg: headache response at 4 hours

In comparisons with sumatriptan 100 mg and rizatriptan 10 mg, naratriptan 1 m and 2.5 mg were less effective at four hours. There was no difference between naratiptan 2.5 mg and zolmitriptan 2.5 mg.

Comment

These results are difficult to compare with those of other interventions for acute migraine that used more conventional (and probably more relevant) two hour outcomes. Limited information at two hours indicates that naratriptan 2.5 mg is considerably less efficacious than other triptans at usual doses.