A study reveals that certain newer migraine medications are less effective than older ones.

A study reveals that certain newer migraine medications are less effective than older ones.

Although migraine attacks can be excruciating, numerous medications can be used to treat them. Certain triptans may be a better migraine treatment than more recently developed drugs, according to a systematic review and network meta-analysis. Recommendations for treating migraines may benefit from the review’s conclusions. Choosing the appropriate medication to treat migraine attacks can significantly improve symptom relief. Experts are looking for and comparing the best options for medications.

The options for treating migraine attacks with oral monotherapy were compared in a systematic review and network meta-analysis published in. The study examined data from 137 randomized controlled trials, involving nearly 90,000 individuals. All things considered, eletriptan was the best at curing pain after two hours and among the best at bringing about long-lasting pain relief. Additionally, the data suggested that some triptan treatments were superior to more modern migraine medications like ubrogepant and lasmiditan.

Most triptans are better for pain relief than newer migraine drugs
Among the many symptoms of a migraine attack are excruciating headaches that can linger for days. One common option for symptom relief is medication. Triptans are one class of drugs used to treat acute migraines; in the end, these medications help to improve migraine symptoms by constricting blood vessels and blocking pain signals.

In this review, researchers aimed to compare migraine treatments that could be administered orally. The Cochrane Central Register of Controlled Trials and the World Health Organization International Clinical Trials Registry Platform were two of the sources they searched for studies. Among them were double-blind, randomized controlled trials that contrasted oral drugs with a placebo or alternative therapy.

Those with a migraine diagnosis and a minimum age of 18 were eligible to participate in the trials. Two hours after taking medication and two to twenty-four hours after taking medication were the focus of the research. They examined the effects of 17 different drugs and included 137 randomized controlled trials. Of the participants, 26,763 were given a placebo and 62,682 received drug-based treatments.

Every drug worked better than a placebo. Researchers compared the drug interventions and discovered that, in terms of participants using rescue medications and achieving pain relief at the 2-hour mark, eletriptan outperformed nearly all other active interventions. The next most effective drugs at two hours were zolmitriptan, sumatriptan, and rizatriptan. Researchers who looked at long-term pain relief discovered that ibuprofen and eletriptan worked best.

The more recently developed migraine treatment drugs, lasmiditan, rimegepant, and ubrogepant, were found to be less effective than eletriptan, rizatriptan, sumatriptan, and zolmitriptan. According to our analysis, the best drugs for treating acute migraine attacks are zolmitriptan, rizatriptan, sumatriptan, and eletriptan. This new understanding indicates that the current guidelines, which treat all oral triptans as equally viable, need to be revised. Our results unmistakably show a preference order for triptan use, a change that calls for revisions to our clinical practice guidelines. On the other hand, it is now demonstrated that almotriptan, frovatriptan, and naratriptan are less effective.

Should more people be using triptans for migraine?
Approximately 10% of the global population experiences migraines. It’s crucial to provide treatment alternatives, and information such as this review might assist in shaping treatment suggestions in the long run. Cipriani pointed out that despite their efficacy, triptans are underutilized, as per European population-based statistics, with only 3.4% to 22.4% of migraine sufferers utilizing triptans. Our findings indicate that certain triptans are the most potent oral medication for alleviating acute migraine attacks, emphasizing the necessity to enhance knowledge among healthcare providers and policymakers to promote improved patient care.

It is my hope that this study will contribute to the awareness of particular migraine treatments. One advantage is that this research may facilitate discussions about particular migraine treatments with primary care physicians. It is important to talk with medical professionals about using the recommended dosage of triptan and switching to a different medication when necessary. Another crucial point is that, given the expense of gepants for some migraine sufferers, particularly in underdeveloped nations, triptans may be more widely available than them.

Triptans are the preferred treatment option for the relief of moderate-to-severe migraine pain, according to the National Institute of Neurological Disorders and Stroke, so it’s important to keep that in mind as well. Additionally, some triptan side effects that physicians should take into account in clinical practice were highlighted in this review. For instance, chest pain was linked to eletriptan. The review authors also mentioned that some people are not always safe to take triptans. They added that more investigation may be needed to reevaluate the vascular contraindications to triptans.

How surprising were these results?
In Fountain Valley, California, at the Spine Health Center at MemorialCare Orange Coast Medical Center, Medhat Mikhael, MD, a pain management specialist and medical director of the nonoperative program, who was not involved in the review, stated he did not find the results surprising. I anticipated these outcomes because, as he explained, the triptan family of medications acts by binding to serotonin receptors, which causes the trigeminal artery to vasoconstriction, effectively and swiftly ending an acute migraine attack.

Hormonal fluctuations, genetic predispositions, and various triggers are among the causes of migraine. He explained that a migraine is caused by inflammation and dilation of the trigeminal artery, which results in a throbbing headache and other related symptoms. Nevertheless, it is important to realize that triptans constrict other blood vessels, such as the coronary arteries, in the same way that they constrict the trigeminal artery. For this reason, patients with cardiac disorders or other cardiovascular diseases should not take them. Mikhael warned that they can also result in other unpleasant side effects, such as tightness in the chest.

How strong is the evidence supporting these findings?
One of the review’s limitations is that certain data may have been overlooked or excluded from the analysis due to the inclusion and exclusion criteria that were set. For instance, the researchers only included studies with outpatient participants and only drugs that complied with specific guidelines. The authors admitted that it’s possible they counted some studies twice or overlooked others when doing their analyses.

The results might have been impacted by the data that was used, such as the decision to include both published and unpublished studies. Additionally, participants with missing data were thought to have had unfavorable results and were limited to viewing data on pain relapse on three different medications for a maximum of two days. It is important to exercise caution when examining the results of this review and analysis because they make the assumption that it is possible to draw valid conclusions from this data in an indirect manner.

Furthermore, it’s critical to recognize that each included study has unique limitations that could have had an impact on the final results. For instance, a number of the studies were funded by the pharmaceutical industry, suggesting potential bias. More diverse study cohorts may be needed in the future because the majority of participants were female and the majority of trials originated in America and Europe. Additionally, the researchers did not have data on combination drugs or the administration of medications through alternative routes, nor did they have individual patient data.

Moreover, they did not concentrate on data regarding response consistency between migraine episodes, cost-effectiveness, or the kind of oral formulation. They did not examine certain clinical issues that could direct treatments in the clinical setting, nor were they able to quantify certain outcomes. It’s also important to remember that the researchers’ analysis of the evidence’s degree of certainty revealed that it ranged from high to extremely low. They admonished us that, for the majority of comparisons, our findings could be considered low or very low.

They discovered that a small number of studies had a high risk of bias for some outcomes, that most outcomes showed moderate heterogeneity, and that some outcomes showed inconsistent comparisons. Lastly, the researchers pointed out that one study with a low placebo response may have contributed to the observed efficacy of ibuprofen in achieving sustained pain freedom. Notwithstanding these drawbacks, the findings demonstrate how some triptans are still useful and effective treatments for migraines, even in the presence of more recent drugs.

References:
https://www.medicalnewstoday.com/articles/older-migraine-drugs-more-effective-than-some-newer-options-study-finds#How-strong-is-the-evidence-supporting-these-findings?

https://mygenericpharmacy.com/category/products/disease/migraine-headaches

Leave a Reply

Your email address will not be published.