- Researchers are reporting that triptans are the most effective medications for treating migraine attacks.
- Ergots and antiemetics were found to be the second most effective medications.
- The scientists stress that there are many different effective options for treating migraine attacks.
Triptans sold under brand names such as Imitrex, Zomig, Maxalt are the most effective in treating migraine attacks, according to a study published today in the online issue of Neurology.
Other classes of medications, such as ergots and anti-emetics, were found to be two to three times more effective than ibuprofen, which is sold under brand names such as Advil and Motrin.
Researchers looked at 25 medications among seven drug classes to determine which were most effective at treating migraine attacks compared to ibuprofen.
The scientists collected data over six years on more than 4.7 million treatment attempts by nearly 300,000 people via a smartphone app. The app collected information based on user input, frequency, triggers, symptoms, medication, and medication effectiveness.
The researchers reported the top three classes of drugs were:
- Ergots (Migranal, Trudhesa, Cafergot, Ergomar, Ergostat)
- Anti-emetics (Reglan, Compro)
The participants reported ibuprofen to be effective 42% of the time.
“Ibuprofen is often underdosed in order to limit side effects like stomach irritation, and that underdosing increases the risk of recurrence,” said Dr. Noah Rosen, the vice chair of neurology at Northwell Health in New York who was not involved in the study.
“Additionally, the half-life of the drug is quite short — that is how long the medication stays active in your body,” Rosen told Medical News Today. “Other comparable medications like naproxen stay in the system much longer, preventing the recurrence of the headache. While ibuprofen has moderate benefit, particularly for individuals with less frequent events or concurrent neck pain or jaw pain, there are other more specific choices that can have a greater likelihood of response as well as less likelihood the headache will return.”
According to the study, the top three medications were:
- Eletriptan (6 times more effective than ibuprofen)
- Zolmitriptan (5.5 times more effective than ibuprofen)
- Sumatriptan (5 times more effective than ibuprofen)
The participants indicated that eletriptan was helpful 78% of the time, zolmitriptan was helpful 74% of the time, and sumatriptan was helpful 72% of the time.
The researchers also looked at other groups of medication, such as acetaminophen (Tylenol) and other nonsteroidal anti-inflammatory drugs (NSAIDs). The NSAIDs other than ibuprofen were 94% more effective. A common combination of acetaminophen, aspirin, and caffeine was 69% more effective than ibuprofen.
Acetaminophen alone was helpful 37% of the time, compared to 42% for ibuprofen.
The scientists looked at other NSAIDs, which they reported were all more effective than ibuprofen:
- Ketorolac (Toradol) was helpful 62% of the time
- Indomethacin (Tivorbex) was helpful 57% of the time
- Diclofenac (Flector, Cambia, Zipsor) was helpful 56% of the time
“I am not surprised by these results,” said Dr. Medhat Mikhael,a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California. “Triptans and ergots are very effective at treating migraines, which are caused by vasodilation of the arteries. These medications constrict the arteries, relieving the pain.”
“Ibuprofen treats inflammation. It is good for arthritis and other inflammatory conditions,” Mikhael, who was not involved in the study, told Medical News Today. “Ibuprofen might drop the pain level of a migraine down, but it usually doesn’t get rid of it. Another problem with ibuprofen is how quickly it leaves your system. It might start relieving symptoms and then two hours later the pain returns.”
The authors note that there are many treatment options available for relieving migraine.
“For people whose acute migraine medication is not working for them, 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,” said Dr. Chia-Chun Chiang, a study author and neurologist at the Mayo Clinic in Rochester, Minnesota, and a member of the American Academy of Neurology.
The researchers reported that a limitation of their study is that the results were user-reported and could be influenced by any number of factors, including a user’s expectations of the medication.
Another limitation is that there are newer migraine medications, gepants (ubrogepant, atogepant, and rimegepant) and ditans (Lasmiditan), that were not included in the research because there was only limited data on them at the time of the study.
Migraine is a neurological condition or syndrome, not just a headache, according to UC Davis Health.
Headaches are a key symptom but not always present during a migraine. The headache pain is caused by nerve-controlled inflammation of the dura, or the membrane between the brain and the skull.
It is characterized by recurrent attacks of moderate to sever throbbing and pulsating pain on one side of the head, according to the National Institute of Neurological Disorders and Stroke.
“Migraine is more than just bad head pain,” Rosen noted. “It is the associated symptoms that often sets it apart. Throbbing one-sided pain that lasts anywhere from 2 to 24 hours in a stereotyped fashion is classic of a migraine. Typically, these worsen with movement and are moderate to severe in intensity. These events are either associated with light and sound sensitivity or nausea and vomiting. Many people may have other associated symptoms such as prodromal or post-dromal states (that is before or after the actual head pain) that consist of things like behavioral changes, yawning, food cravings and change in level of energy.”
Migraine is most common in adult women and can be connected to changes in hormones.