An extensive review of clinical trials has revealed that a lesser-used category of drugs may outperform more expensive medications in managing migraine symptoms. Despite their design for migraine treatment, triptans are currently utilized in less than 22% of migraine cases. Researchers advocate for considering these low-cost triptans as a first-line treatment option, provided patients are free from contraindicating medical conditions like cardiovascular disease.
Experts emphasize the importance of collating existing data to inform primary care physicians about the effectiveness of triptans when other treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), have been unsuccessful. Notable triptan medications include sumatriptan and eletriptan, which have been available worldwide since 1991 and are now offered in generic forms. However, concerns regarding cardiovascular risks, particularly in patients with existing heart conditions, have been noted.
To address these risks, pharmaceutical companies have introduced newer classes of drugs known as ditans and gepants. Though these alternatives, such as lasmiditan, rimegepant, and ubrogepant, avoid cardiovascular complications, they come with a steep price—Eli Lilly’s branded lasmiditan, Reyvow, costs approximately $92.50 per tablet, contrasting sharply with the $17 price tag of generic eletriptan.
In addition to these options, patients may also consider NSAIDs like ibuprofen and analgesics such as paracetamol for migraine relief. Prior studies have extensively evaluated the efficacy, safety, and side effects of various migraine treatments, yet comparative analyses have been limited. To remedy this, researchers examined 137 double-blind, randomized controlled trials conducted globally since 1991, encompassing 89,445 adult participants.
The trials assessed the efficacy of 17 oral medications against a placebo or alternative drugs, using criteria from the International Headache Society to measure how effectively each medication managed pain over specific time periods. Results indicated that eletriptan was the most effective for immediate pain relief within two hours, followed closely by rizatriptan, sumatriptan, and zolmitriptan. For sustained relief over 24 hours, eletriptan and ibuprofen emerged as the top contenders.
Conversely, the newer medications lasmiditan, rimegepant, and ubrogepant demonstrated no superior effectiveness over paracetamol or most NSAIDs and presented a higher risk of side effects such as nausea. Consequently, these newer drugs should be regarded as “third-line options.”
The findings suggest that specific triptans could significantly benefit some migraine sufferers, though individual treatment needs may vary. As one expert highlights, migraine is a highly personal condition that requires tailored treatment strategies rather than a one-size-fits-all approach. Meta-analyses can inform population-level insights, but they may not sufficiently address individual patient needs.
