Simultaneous head-to-head comparison of 25 migraine medications

Triptans, ergots, and anti-emetics emerged as the most effective medications from an international study simultaneously comparing 25 acute migraine medications head-to-head. From their big-data analysis approach, analysing close to 11 million patient records of migraine attacks, the researchers concluded that the results offer generalisable insights that complement clinical practice.

A head-to-head comparison of treatment effectiveness based on real-world patient experience of this scale had yet to be performed. The American-Japanese group had consented access to 10,842,795 records of migraine attacks, which had been gathered in a smartphone application featuring an e-diary called Migraine Buddy [1]. A filtering criterium was ‘English speaking user.’ The researchers focused on 25 acute medications in 7 classes: acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), triptans, combination analgesics, ergotamines, anti-emetics, and opioids. Due to the relatively low number of users, the analysis did not include gepants and ditan. The researchers used a 2-level nested logistic regression model to estimate the odds ratio (OR) of effectiveness after adjusting for pain intensity, other concurrent medications, and the covariance within the same user for each medication.

The final analysis included 4,777,524 medication-outcome pairs from 3,119,517 migraine attacks among 278,006 users. Ibuprofen was used as the reference. Triptans were found to have the highest efficacy, with a mean OR of 4.8, followed by ergotamines (OR 3.02) and anti-emetics (OR 2.67), opioids (OR 2.49), NSAIDs (OR 1.94), acetaminophen/acetylsalicylic acid/caffeine (OR 1.69), others (OR 1.49), and acetaminophen (OR 0.83). Individual medications with the highest ORs were eletriptan (OR 6.1), zolmitriptan (OR 5.7), and sumatriptan (OR 5.2). All estimated ORs were statistically significant, except for that of acetylsalicylic acid. The nested logistic regression model achieved an excellent area under the curve (AUC) of 0.849.

1. Chiang CC, et al. Simultaneous Comparisons of 25 Acute Migraine Medications: A Big Data Analysis of 10 Million Patient Self-Reported Treatment Records From A Migraine Smartphone Application. S41.001, AAN 2023 Annual Meeting, 22–27 April, Boston, USA.

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Posted on 26 June, 20238 February, 2024