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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?

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Triptans are the most successful drugs for treating migraine attacks, according to research. The second most effective drugs were discovered to be ergots and antiemetics. The researchers emphasize that there are numerous, efficient methods for treating migraine episodes. The most successful treatment for migraine attacks is triptans, which are marketed under brands like Imitrex, Zomig, and Maxalt, according to a study that was just published online in the Neurology journal. Ibuprofen, which is marketed under the brands Advil and Motrin, has been found to be two to three times less effective than other classes of medications, such as ergots and antiemetics. Comparing 25 drugs from seven different drug classes, researchers looked at which ones worked best for treating migraine attacks when compared to ibuprofen. Using a smartphone app, the scientists gathered data on over 4.7 million treatment attempts made by almost 300,000 people over the course of six years. Based on user input, frequency, triggers, symptoms, medication, and medication effectiveness, the app gathered data. The top three drug classes, according to the researchers, were: Triptans; Ergots (Migranal, Trudhesa, Cafergot, Ergomar, Ergostat); Antiemetics (Reglan, Compro); and 42 percent of the participants said ibuprofen was effective.

Dr. Noah Rosen, the vice chair of neurology at Northwell Health in New York and an unaffiliated third party, stated that underdosing on ibuprofen raises the risk of recurrence. Underdosing is frequently done to minimize side effects such as stomach irritation. Furthermore, Rosen told Medical News Today that the drug’s halflife—the amount of time it remains active in your body—is relatively brief. Some similar drugs, such as naproxen, remain in the body for a lot longer and stop headaches from coming back. Ibuprofen has a moderate benefit, especially for those who experience less frequent events or who also have neck or jaw pain, but there are other more targeted options that may be more effective and less likely to cause a recurrence of the headache. Eletriptan (6 times more effective than ibuprofen), Zolmitriptan (5 times more effective than ibuprofen), and Sumatriptan (5 times more effective than ibuprofen) were the top three medications, according to the study. The participants reported that eletriptan was helpful 78% of the time, zolmitriptan 74% of the time, and sumatriptan 72% of the time. Other medication classes, including acetaminophen (Tylenol) and other nonsteroidal anti-inflammatory drugs (NSAIDs), were also examined by the researchers. The effectiveness of the NSAIDs other than ibuprofen was 94% higher. A popular mix of aspirin, caffeine, and acetaminophen was found to be 69% more effective than ibuprofen. Only acetaminophen proved beneficial 37% of the time.

I am not surprised by these results, said Dr. Medhat Mikhael, a pain management specialist and medical director of the nonoperative program at the Spine Health Center at Memorial Care Orange Coast Medical Center in California. The scientists looked at other NSAIDs and found that all of them were more effective than ibuprofen. Ketorolac (Toradol) was helpful 62 percent of the time. Indomethacin (Tivorbex) was helpful 57 percent of the time. Diclofenac (Flector, Cambia, Zipsor) was helpful 56 percent of the time. Since migraines are brought on by artery vasodilation, triptans and ergots are excellent treatments. By narrowing the arteries, these drugs reduce pain. Inflammation is treated by ibuprofen. Medical News Today was informed by Mikhael, who was not involved in the study, that it is beneficial for inflammatory conditions such as arthritis. Ibuprofen typically doesn’t completely eliminate migraine pain, but it may lessen its intensity. The speed at which ibuprofen leaves your system is another issue. It may begin to relieve symptoms, but after two hours the pain might return. The authors point out that there are numerous migraine relief treatment options available. Dr. ChiaChun Chiang, a study author and neurologist at the Mayo Clinic in Roch, stated, “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.”.

One of the study’s limitations, according to the researchers, is that the results were self-reported by the participants, meaning that a variety of factors, such as the participants’ expectations of the medication, could have an impact. Another drawback is that the study did not include more recent migraine drugs, such as ditans (Lasmiditan) and gepants (ubrogepant, atogepant, and rimegepant), because there was insufficient information available about them at the time of the investigation. According to UC Davis Health, migraine is a neurological disorder or syndrome rather than just a headache. Although they are a crucial symptom, headaches do not always accompany migraines. The membrane separating the brain and the skull, known as the dura, is inflamed under nerve control, which is what causes headache pain. The National Institute of Neurological Disorders and Stroke describes it as occurring on one side of the head and characterized by recurrent episodes of moderate to severe throbbing and pulsating pain. Rosen pointed out that migraine is more than just severe headaches. It is frequently distinguished by the accompanying symptoms. The classic migraine pain is sharp, one-sided pain that lasts in a typical way for two to twenty-four hours. These are usually moderate to severe in intensity, and they usually get worse when moving. These incidents are linked to either nausea and vomiting or sensitivity to light and sound. Prodromal or postdromal states, which occur before or after the actual head pain, can cause behavioral abnormalities, yawning, food cravings, and changes in energy levels in a lot of people. Hormonal fluctuations may play a role in the prevalence of migraines in adult women.

REFERENCES:

https://www.medicalnewstoday.com/articles/certain-migraine-medications-may-be-more-effective-than-ibuprofen#What-is-migraine?
https://www.sciencedaily.com/releases/2023/11/231129174011.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935632/
https://www.withcove.com/learn/best-over-the-counter-migraine-medication

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About 3–10% of kids suffer from migraines. Up until puberty, when roughly half of these kids or young teens stop having migraine episodes, the prevalence rises with age. Alternatively, if a person develops migraines in their adolescence, they are more likely to carry the illness into adulthood. Males and females are equally likely to experience migraines prior to puberty. Females are more likely to experience it after puberty. Many of the symptoms experienced by adults with migraines also affect children. The symptoms can include a headache that lasts for two to seventy-two hours, a headache on one side of the head, moderate to severe pain, pain that worsens with physical activity, nausea or vomiting aura, and sensory disturbances like flashing lights in the field of vision, which may be the first symptom. According to the National Migraine Centre of the United Kingdom, children are more likely than adults to experience pain in multiple locations or throughout the entire head. Children’s episodes might also be shorter than adults’. Since they might not be able to articulate their symptoms, young children can be challenging to diagnose with migraines. The subjectivity of pain intensity presents another difficulty because there may be little to no comparison between children and their parents or other caregivers. For these reasons, migraines in children under the age of two are rarely diagnosed by physicians.

Lastly, it is important to remember that a headache may not occur at all or only be a minor symptom for some migraine sufferers. Why certain children suffer from migraines while others do not is a mystery to researchers. There may be a genetic component to migraine, though, as many children who suffer from the disorder have family members who also have it. It is recognized by experts that specific genetic mutations can predispose children to specific migraine types. A mutation in any of the following genes could be the cause of hemiplegic migraine, for instance, which is a form of the disease that results in momentary weakness and paralysis in children. Research into the causes of other migraine types is still ongoing. Migraine sufferers frequently discover that particular meals, circumstances, or outside elements set off migraine attacks. Finding these triggers can frequently aid in averting the episodes. Finding the triggers, though, can take some time. It’s also important to remember that a migraine episode can develop as a result of multiple triggers overlapping. Recording a child’s migraine symptoms and any potential causes can be beneficial.

In the section below on home care, we provide detailed instructions on what to write down. A child may experience an episode if they sleep too much or too little. These are common triggers to take into account. Creating and adhering to a regular sleep schedule could be beneficial. Making sure a child drinks enough water can help lessen the symptoms of migraines, especially after physical activity. Certain foods and insufficient eating can both cause symptoms. When a child exhibits symptoms, record what they’ve eaten and look for patterns. Overstimulation and stress can aggravate migraines. A child who experiences stress and anxiety on a regular basis might find it helpful to have a quiet area where they can decompress. Children’s mindfulness exercises could be beneficial as well. Changes in the weather, secondhand smoke, and bright lights, such as those on computer or phone screens may be among them.

While avoiding certain migraine triggers can help lessen the frequency of episodes, not all migraine triggers can be avoided. A doctor may prescribe an appropriate over-the-counter (OTC) medication if a child is having migraine symptoms. Examples of OTC medications include acetaminophen (Tylenol) every 4-6 hours, ibuprofen (Advil) every 6-8 hours, and naproxen (Aleve) every 8-12 hours. However, not all children can take these medications or use the recommended dosages. Before giving any over-the-counter medication to a child, have a conversation with a doctor or pharmacist. A child may also be prescribed a medication from the triptan family if they have severe or frequent migraine attacks. These are especially effective in averting migraine attacks.

Both rizatriptan (Maxalt) and sumatriptan (Imitrex) have been given FDA approval for use in pediatric patients. In addition to giving medication and assisting in preventing exposure to triggers, caregivers and children can also use other strategies to manage migraine symptoms. When a child experiences migraine symptoms, try moving them to a quiet, darkened room, applying cool or warm compresses to their head, offering them an eye mask to block out any light, massaging any tense or sore muscles, and encouraging them to sleep, if this helps. Anyone keeping a symptom diary should record the time and date that the symptoms occurred, the length and severity of the episode, and whether any treatments or strategies help.

Having a plan in place before experiencing a migraine may lessen its effects. One may create one or more migraine kits with supplies like medicine, water, hot or cold packs, an eye mask, and a symptom log. Acquire knowledge about plausible triggers and pinpoint particular ones. Assist in finding any early warning indicators of the onset of symptoms. Notify daycare facilities, schools, and other caregivers about the child’s experiences and what to do in the event of a migraine attack. It’s important to remember that giving painkillers as soon as you can might help halt the migraine episode’s progression.

Determining the severity of a child’s migraine symptoms can be challenging. Depending on how old they are, they might not comprehend or be afraid of their condition. Being comforting and composed is crucial during an episode. After that, educating the child about the ailment or having a doctor explain it to them may be beneficial. Certain fears may be allayed if one knows what a migraine is and that every episode ends eventually. The child may also benefit from taking the initiative to manage the illness, such as by maintaining or assisting with a symptom diary. Speak with a physician regarding a child’s migraine symptoms. In order to lessen the intensity and frequency of episodes, they might recommend medicine. It’s crucial that they rule out any other potential reasons for the symptoms. Certain symptoms of migraines can be mistaken for more serious medical conditions. If a child has any of the following symptoms: stiff neck, confusion, seizure, loss of consciousness, sudden, severe headache without other migraine symptoms, headache with the worst pain they have ever experienced, headache after a head injury, or any combination of these, seek emergency medical attention. Consult a doctor immediately if a child has migraine symptoms along with changes in vision, balance, or coordination, excessive vomiting, persistent pain, or a recent change in personality or behavior. Migraine is a common condition in children, and the symptoms can start early. As soon as symptoms appear, taking over-the-counter painkillers may reduce or eliminate their effects. Alternatively, a physician might recommend specific migraine drugs. If you experience any migraine symptoms, it’s critical to see a doctor. Certain symptoms can mimic those of other health problems, so a doctor needs to be certain of the cause. Apart from recommending medication, the physician can offer advice on recognizing triggers and controlling episodes.

REFERENCES:

https://www.medicalnewstoday.com/articles/migraines-in-children#summary
https://www.mayoclinic.org/diseases-conditions/headaches-in-children/symptoms-causes/syc-20352099
https://www.ncbi.nlm.nih.gov/books/NBK557813/
https://www.health.harvard.edu/blog/8-things-to-watch-for-when-your-child-has-a-headache-2017051611761

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A recent study found that a red wine compound influences the way the body metabolizes alcohol, which may contribute to headaches. Because red wine contains more histamine, tannins, and quercetin than white wine, red wine is more likely to give headaches. Experts advise consuming white wine, drinking plenty of water, and avoiding drinking right before bed to reduce headaches. Wine is usually the preferred alcoholic beverage during the holidays. Unfortunately, some people can get a headache from even a small amount of wine—red wine in particular. A recent investigation into the causes of headaches associated with red wine as opposed to other alcoholic beverages that don’t have the same effect was published in the journal Scientific Reports. It has been found by researchers that the high flavonoid content of red wine, specifically quercetin, affects the way the body metabolizes alcohol, which can cause headaches. It’s interesting to note that fruits and vegetables alike contain the antioxidant quercetin. However, it may have unfavorable side effects if combined with alcohol.

Wine chemist and corresponding author Dr. Andrew Waterhouse, professor emeritus in the UC Davis Department of Viticulture and Enology, told Medical News Today, “The most interesting aspect of this project is that the effect is not direct.”. To put it another way, we discovered that quercetin glucuronide was the “culprit,” but if you ate it in another meal, you wouldn’t experience a headache. Our hypothesis states that a headache can only happen if alcohol and quercetin are consumed at the same time. That, in my opinion, explains why things have taken so long to resolve, stated Dr. Waterhouse. According to Cleveland Clinic neurologist Dr. MaryAnn Mays, “red wine contains more tannins and histamines compared to white wine, which are contributing factors of headaches.”. Another possible factor, quercetin, may be the cause of red wine headaches in humans. In particular, when quercetin is metabolized with alcohol, its form changes. According to Carolyn Stolte, a certified nurse practitioner with Mercy Personal Physicians in Baltimore, Maryland, “questercetin converts to a different form—quercetin glucuronide—when it interacts with alcohol during metabolism.”. Researchers discovered that acetaldehyde, a known toxin, accumulates as a result of this metabolism. She clarified, “This results in the traditional red wine side effects of flushing, headaches, and nausea.

According to Stolte, red wine has historically been thought to have higher levels of tannins and histamines than white wine, which can cause sensitivity in certain individuals. Because quercetin in wine can trigger headaches in certain people, even small amounts of wine can cause headaches. Furthermore, grape cultivation affects quercetin levels; exposure to sunlight during growth may result in a higher content of quercetin. “When we drink alcohol, our bodies start working quickly to break it down into other compounds that are easier to get rid of,” said Dr. Nate Wood, a medical education fellow and instructor at the Yale School of Medicine’s department of general internal medicine. Acetaldehyde is one of these substances. Many of the unpleasant hangover symptoms that we are all familiar with, such as headaches, have been linked to acetaldehyde use. Luckily, acetaldehyde is also broken down by an enzyme that is produced by our bodies. “It’s known as aldehyde dehydrogenase,” he said. Quercetin-3-glucuronide, a derivative of quercetin found in red wine, might function similarly. Dr. Wood continued, “New research demonstrates that it is effective in blocking aldehyde dehydrogenase.”

Similar to individuals with the genetic variation, acetaldehyde accumulates, aldehyde dehydrogenase becomes less effective, and headaches result. This quercetin derivative has been found to be present in higher concentrations in red wine than in white wine, which may help to explain why red wine appears to give people headaches more often than white wine. The first thing to realize is that, according to Mays, “there are two parts of alcohol metabolism: alcohol dehydrogenase and acetaldehyde dehydrogenase.”. “Quercetin may be obstructing that metabolism, leading to an accumulation of acetaldehyde.”. It might also be necessary to account for a genetic component. According to Mays, “some people may not have the enzyme that breaks down histamines in wine to metabolize alcohol.”. “Those people are more vulnerable. For instance, about 40% of people from Eastern Asia report having negative alcohol-related side effects, such as headaches and facial flushing. In particular, their aldehyde dehydrogenase is dysfunctional. “Some Eastern Asians have higher blood levels of acetaldehyde when they drink, which can lead to more negative side effects from alcohol, such as headaches, fast heart rate, nausea, and facial flushing,” Dr. Wood said.

“Red wine will probably have the same physiological effects on them as other forms of alcohol. Since the enzyme already fails to function, the quercetin derivative cannot impede its ability to inhibit the aldehyde dehydrogenase enzyme, he said. But when it comes to red wine, those with functional aldehyde dehydrogenase in their bodies might experience more severe headaches than with other forms of alcohol. According to Dr. Wood, this is because the quercetin derivative is preventing their body’s aldehyde dehydrogenase from functioning properly. According to Stolte, our understanding of why some people are more susceptible to wine-induced headaches is still evolving.”. According to recent research, wine sensitivity may be influenced by genetics. There may be a genetic component to how different people metabolize substances like quercetin, tannins, and histamines,” he continued. According to Stolte, it’s also critical to consider the person’s overall health and any underlying medical conditions. For instance, compared to the general population, people with underlying migraines are more likely to suffer wine-induced headaches. The University of California scientists hope to investigate this further in the future, she said. Women are also more prone to wine-related headaches. According to Dolores Woods, a registered dietitian at the UTHealth Houston School of Public Health, “women have more body fat than men, which stores alcohol. Women metabolize alcohol more slowly than men do because they have less alcohol dehydrogenase (the enzyme responsible for alcohol metabolism) in their blood.

REFERENCES:

https://www.medicalnewstoday.com/articles/headaches-after-drinking-red-wine-flavanols-quercetin#Why-some-people-are-more-susceptible-to-wine-headaches-than-others
https://www.health.harvard.edu/diseases-and-conditions/ask-the-doctor-what-causes-red-wine-headaches
https://www.healthline.com/health/wine-headache
https://www.everydayhealth.com/headache/does-drinking-red-wine-give-you-a-headache-a-new-study-may-explain-why/

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