Some older triptan drugs are better at relieving acute migraine pain than newer drugs, a systematic review and analysis of 137 randomized controlled trials suggests. As published in BMJ, researchers considered pain relief and freedom from pain at 2 hours in addition to sustained freedom from pain at 24 hours for nearly 90,000 participants who were randomized to one of 17 oral migraine drugs or placebo. All 17 drugs studied were more effective than placebo. Eletriptan was the most effective drug for pain relief at 2 hours, with odds ratios (ORs) ranging from 1.46 to 3.01, followed by rizatriptan (ORs from 1.59 to 2.44), sumatriptan (ORs from 1.35 to 2.04), and zolmitriptan (ORs from 1.47 to 1.96). Migraine drugs more recently coming to market that were included in the study were lasmiditan (a serotonin 5-HT 1F receptor agonist) as well as 2 calcitonin gene-related peptide antagonists, rimegepant and ubrogepant. Researched showed lasmiditan, rimegepant, and ubrogepant demonstrated efficacy comparable to acetaminophen (paracetamol) and most of the non-steroidal anti-inflammatory drugs studied.
Underutilized treatment option: The research suggests that existing guidelines for migraine treatment should be revisited. Triptan drugs are generally less expensive generics because they have been on the market for many years, and study authors say they are currently underutilized. In practice, however, triptans are not daily medications and typically have a limit to how often they can be taken.
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