Triptans, Ergots, Antiemetics Most Effective Meds for Migraine

Nov 30, 2023

WEDNESDAY, Nov. 29, 2023 (HealthDay News) — Triptans, ergots, and antiemetics are the most effective classes of medications for migraine, according to a study published online Nov. 29 in Neurology.

Chia-Chun Chiang, M.D., from the Mayo Clinic in Rochester, Minnesota, and colleagues conducted a retrospective analysis of 10,842,795 migraine attack records to compare treatment effectiveness. Twenty-five acute medications among seven classes were analyzed; the final analysis included 4,777,524 medication-outcome pairs from 3,119,517 migraine attacks in 278,006 medication users.

The researchers found that the top three classes of medications with the highest effectiveness were triptans, ergots, and antiemetics (mean odds ratios, 4.80, 3.02, and 2.67, respectively), followed by opioids, nonsteroidal anti-inflammatory drugs (NSAIDs; other than ibuprofen), combination analgesics (acetaminophen/acetylsalicylic acid/caffeine), others, and acetaminophen (mean odds ratios, 2.49, 1.94, 1.69, 1.49, and 0.83, respectively) compared with ibuprofen. Eletriptan, zolmitriptan, and sumatriptan were the individual medications with the highest odds ratios (6.1, 5.7, and 5.2, respectively). The odds ratios of acetaminophen, NSAIDs, combination analgesics, and opioids were mostly around or less than 1 compared with ibuprofen, suggesting similar or lower reported effectiveness. Except for that of acetylsalicylic acid, the odds ratios for 24 medications achieved statistical significance; an area under the curve of 0.849 was achieved using the nested logistic regression model.

“For people whose acute migraine medication is not working for them, our hope is that this study shows that there are many alternatives that work for migraine, and we encourage people to talk with their doctors about how to treat this painful and debilitating condition,” Chiang said in a statement.

Several authors disclosed ties to the pharmaceutical and other industries.

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