A Cochrane review [Abstract] 1 included 25 studies with a total of 20,162 patients. Patients in all of the studies were diagnosed with migraine with or without aura in accordance with the IHS criteria, typically had a history of migraine for more than one year, and suffered from 1 to 6 migraine attacks per month. Most of the data were for the 2.5 mg and 5 mg doses vs. placebo, for treatment of moderate to severe pain. For oral zolmitriptan 2.5 mg vs. placebo, the NNTs were 5.0 for pain free at 2 hours (11 studies, 5223 attacks), 3.2 for headache relief at 2 hours (11 studies, 4567 attacks), 7.7 for sustained painfree (2 studies, 984 attacks) and 4.1 for sustained headache relief (4 studies, 1457 attacks) during the 24 hours postdose. Results for the oral 5 mg dose were similar to the 2.5 mg dose. For headache relief at 1 and 2 hours and sustained headache relief during the 24 hours postdose, 5 mg nasal spray was more effective than the 5 mg oral tablet (relative benefit of treatment vs. placebo: oral tablet: 1.9 (1.8 to 2.1) and NNT 3.5 (8 studies, n=4292); nasal spray: 2.1 (1.9 to 2.2) and NNT 2.9 (3 studies, n=3164)). Adverse events were transient and mild and were more common with zolmitriptan than placebo, with a clear dose response relationship. Oral zolmitriptan 2.5 mg and 5 mg provided headache relief at 2 hours to the same proportion of people as oral sumatriptan 50 mg (66%, 67%, and 68%, respectively; 2 studies, 3242 attacks), although not necessarily the same individuals. There was no significant difference in numbers experiencing adverse events.
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