Neurology
25 migraine medications compared using big data approach
Triptans, ergots, and anti-emetics were associated with higher odds of user-rated, positive response than ibuprofen (Class IV evidence) in this big-data study analyzing the patient-generated, real-time records of more than 10 million migraine attacks comparing 25 medications.
- This retrospective study reviewed 10,842,795 migraine attack records extracted from an e-diary smartphone app between June 30, 2014, and July 2, 2020.
- Researchers analyzed 25 acute medications among seven classes: acetaminophen, NSAIDs, triptans, combination analgesics, ergots, anti-emetics, and opioids.
- Newer migraine medications such as gepants and ditan were not included in the analysis.
- The final analysis included 4,777,524 medication-outcome pairs from 3,119,517 migraine attacks among 278,006 users.
- Triptans (mean odds ratio [OR], 4.8), ergots (mean OR, 3.02), and anti-emetics (mean OR, 2.67) were the classes of medications with the highest effectiveness, followed by opioids (mean OR, 2.49), NSAIDs (other than ibuprofen, mean, OR 1.94), combination analgesics (acetaminophen/acetylsalicylic acid/caffeine) (OR, 1.69; 95% confidence interval [CI], 1.67-1.71), others (OR, 1.49; 95% CI, 1.47-1.50), and acetaminophen (OR, 0.83; 95% CI, 0.83-0.84), using ibuprofen as the reference.
- Individual medications with the highest ORs were eletriptan (OR, 6.1; 95% CI, 6.0-6.3), zolmitriptan (OR, 5.7; 95% CI, 5.6-5.8), and sumatriptan (OR, 5.2; 95% CI, 5.2-5.3).
- The ORs of acetaminophen, NSAIDS, combination analgesics and opioids were mostly around or less than 1, suggesting similar or lower reported effectiveness compared with ibuprofen.
Source:
Chiang CC, et al. (2023, November 29). Neurology. Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users' Self-Reported Records From a Smartphone Application. https://pubmed.ncbi.nlm.nih.gov/38030397/