Migraine is a debilitating neurological condition that affects approximately 10% of the global population. Various medications are available to alleviate symptoms, with both older and newer options vying for effectiveness. Among these, triptans have been widely prescribed for decades, while newer drugs, such as lasmiditan and ubrogepant, have recently been introduced (1^✔ ✔Trusted Source
Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis

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Efficacy of Triptans

A systematic review published in The BMJ explored how triptans compare to more recent migraine treatments. The study included data from 137 randomized controlled trials and evaluated almost 90,000 individuals. It revealed that older medications, particularly certain triptans, are more effective than some newer options.

Researchers conducted a thorough analysis of studies from trusted sources like the Cochrane Central Register of Controlled Trials and the World Health Organization International Clinical Trials Registry Platform. The analysis included double-blind, randomized controlled trials that evaluated the effectiveness of oral monotherapy treatments for migraine attacks. Participants included individuals aged 18 and older with a migraine diagnosis.

The study focused on two key points:

• Freedom from pain 2 hours after medication intake
• Sustained pain relief between 2–24 hours post-medication intake

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Triptans Outperform Newer Drugs

The results of the study showed that all migraine medications outperformed placebos. However, when comparing drug interventions, certain triptans emerged as the most effective for achieving freedom from pain within two hours of intake.

• Eletriptan: This triptan was the most effective in eliminating pain after two hours and also excelled in providing sustained relief from pain.
• Rizatriptan, Sumatriptan, and Zolmitriptan: These triptans followed closely behind eletriptan in effectiveness for pain relief within two hours.
• Ibuprofen: In combination with eletriptan, ibuprofen also provided sustained pain freedom in certain cases.

Researchers found that older triptans, such as eletriptan, rizatriptan, sumatriptan, and zolmitriptan, were more effective than newer migraine medications, such as lasmiditan, rimegepant, and ubrogepant.

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Triptans and Their Role in Migraine Treatment

According to Andrea Cipriani, MD, Ph.D, lead author and professor of psychiatry at the University of Oxford, these findings suggest a need to revise current clinical guidelines for migraine treatment. Triptans are already widely recommended, but this study indicates that specific triptans, such as eletriptan, should be prioritized over others.

Despite their proven effectiveness, triptans are underused globally. In European populations, only 3.4–22.4% of people with migraines use triptans for symptom relief. Cipriani emphasized the need for better education among healthcare professionals to improve treatment strategies and optimize patient outcomes.

Although triptans are effective, they come with side effects that clinicians should consider. For instance, eletriptan has been associated with chest pain, which may limit its use in patients with cardiovascular issues. Triptans are also known to cause vasoconstriction, affecting not only the trigeminal artery (which causes migraines) but also coronary arteries, making them unsuitable for individuals with certain heart conditions.

Further research may be necessary to reassess the vascular contraindications associated with triptan use. However, triptans remain a first-line treatment for moderate-to-severe migraines, as indicated by the National Institute of Neurological Disorders and Stroke.

Older Medications Remain Viable

Medical experts not involved in the study also provided insights into the findings. Medhat Mikhael, MD, a pain management specialist, found the results unsurprising, attributing the effectiveness of triptans to their ability to bind to serotonin receptors and constrict the trigeminal artery, effectively stopping migraine attacks.

However, Dr. Mikhael cautioned against using triptans in patients with cardiovascular diseases due to their vasoconstricting effects on other blood vessels. He emphasized the importance of individualizing treatment options for migraine patients based on their overall health.

Despite the introduction of newer migraine medications, this systematic review highlights that older triptans, such as eletriptan, remain among the most effective options for acute migraine relief. The study suggests that clinical guidelines should be updated to reflect the superior efficacy of specific triptans over newer treatments.

This research may pave the way for better treatment recommendations, improving patient outcomes and guiding healthcare professionals in choosing the most effective migraine medications.

Reference:

1. Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis – (https://www.bmj.com/content/386/bmj-2024-080107)

Source-Medindia