A Cochrane review [Abstract] 1 included 12 RCTs with a total of 4755 patients with migraine. The majority of participants were female (78% to 88%) and had a diagnosis of migraine without aura (70% to 91%). The studies compared intranasal sumatriptan with placebo or an active comparator. Most of the data were for the 10 mg and 20 mg doses. Twenty-four hour sustained efficacy data were reported by only a single trial.
•Sumatriptan 10 mg vs. placebo (8 studies, n=1755): the NNTs were 7.3, 7.4, and 5.5 for pain-free at two hours, and headache relief at one and two hours, respectively.
•Sumatriptan 20 mg vs. placebo (9 studies, n=2020): the NNTs were 4.7, 4.9, and 3.5, respectively, for pain-free at two hours, and headache relief at one and two hours, respectively.
•Sumatriptan 10 mg vs. sumatriptan 20 mg: 20 mg dose was significantly better for pain-free at two hours (p=0.015), and headache relief at one (p=0.023) and two hours (p=0.002).
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) and imprecise results (wide confidence intervals). The quality of evidence is upgraded by large magnitude of effect.
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