Simultaneous head-to-head comparison of 25 migraine medications

An international study conducted a big-data analysis simultaneously comparing 25 acute migraine medications head to head, where close to 11 million patient records of migraine attacks were analysed. Triptans, ergots, and anti-emetics emerged as the most effective medications from this analysis. The researchers said their 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 not been performed before. The American-Japanese group had consented access to 10,842,795 records of migraine attacks, which had been gathered in a smartphone application called Migraine Buddy, which features an e-diary. A filtering criterium was “English speaking user”. The researchers focused on 25 acute medications in 7 classes: acetaminophen, NSAIDs, triptans, combination analgesics, ergotamines, anti-emetics, and opioids. Due to the relatively low number of users, gepants and ditan were not included in the analysis. They used a two-level nested logistic regression model to estimate for each medication the odds ratio (OR) of effectiveness, after adjusting for pain intensity, and other concurrent medications, as well as the covariance within the same user.

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 that of acetylsalicylic acid. The nested logistic regression model achieved an excellent area under the curve (AUC) of 0.849.

1. 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. Session S41.001, AAN 2023 Annual Meeting, 22–27 April, Boston, USA.

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