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Evidence summaries

Rectal Sumatriptan for Acute Migraine

Rectally administered sumatriptan may be effective for acute migraine attacks, but is probably associated with increased adverse events. Level of evidence: "C"

Summary

A Cochrane review [Abstract] 1 included 3 RCTs with a total of 866 patients with migraine. The majority of participants were female (84% to 89%) and had a diagnosis of migraine without aura (67% to 87%). Most of the data were for the 12.5 mg and 25 mg doses. Only one study reported any 24-hour efficacy data. Inconsistent or incomplete reporting prevented any pooled analysis of important secondary outcomes, including use of rescue medication, relief of associated symptoms and incidence of adverse events.

•Sumatriptan 12.5 mg vs. placebo (2 studies, n=235): the NNTs were 5.2, 3.2 and 8.0 for headache relief at one and two hours and relief of functional disability, respectively.

•Sumatriptan 25 mg vs. placebo (2 studies, n=240): the NNTs were 4.2, 3.2, 2.4 and 4.0 for pain-free at two hours, headache relief at one hour, headache relief at two hours and relief of functional disability, respectively. There were no significant differences between the 12.5 and 25 mg doses for any of the outcomes analysed.

For the most part, adverse events were transient and mild and were more common with sumatriptan than with placebo, but there were insufficient data to perform any analyses.

Comment: The quality of evidence is downgraded by study quality (short follow-up time, selective outcome reporting) and imprecise results (wide confidence intervals).

Clinical comments

Note

Date of latest search:

    References

    • Derry CJ, Derry S, Moore RA. Sumatriptan (rectal route of administration) for acute migraine attacks in adults. Cochrane Database Syst Rev 2012;2:CD009664. [PubMed]

Primary/Secondary Keywords