Subcutaneous Sumatriptan in Migraine
Subcutaneous sumatriptan appears to be effective as an abortive treatment for acute migraine attacks, but is associated with increased adverse events. Level of evidence: "B"A Cochrane review [Abstract] 1 included 35 RCTs with a total of 9365 patients with migraine. Most of the data were for the 6 mg dose. Only 5 studies provided any data on the 24-hour sustained efficacy of sumatriptan.
- Sumatriptan 6 mg vs. placebo (13 studies, n=2522): the NNTs were 2.9, 2.3, 2.2, and 2.1 for pain-free at one and two hours, and headache relief at one and two hours, respectively, and 6.1 for sustained pain-free at 24 hours.
- Sumatriptan 6 mg plus optional 6 mg vs. placebo (3 studies, n=388): the NNTs were 2.6 and 2.1 for pain-free at two hours and headache relief two hours, respectively. There was no significant difference in efficacy between a single dose of sumatriptan 6 mg and an initial dose plus an optional second dose after one hour in the event of inadequate relief from the initial dose.
Results for the 4 mg and 8 mg doses were similar to the 6 mg dose, with 6 mg significantly better than 4 mg only for pain-free at one hour, and 8 mg significantly better than 6 mg only for headache relief at one hour.Relief of headache-associated symptoms, including nausea, photophobia, and phonophobia, was greater with sumatriptan than with placebo, and use of rescue medication was lower with sumatriptan than placebo. For the most part, adverse events were transient and mild and were more common with sumatriptan than placebo.
Comment: The quality of evidence is downgraded by study quality (short follow-up time).
References
- Derry CJ, Derry S, Moore RA. Sumatriptan (subcutaneous route of administration) for acute migraine attacks in adults. Cochrane Database Syst Rev 2012;2:CD009665. [PubMed]