Oral Sumatriptan for Acute Migraine
Oral sumatriptan is effective for the treatment of an acute attack of migraine. The 50 mg dose has slightly lower efficacy than 100 mg dose, but is associated with fewer adverse events. Level of evidence: "A"A Cochrane review[Abstract]1 included 61 studies with a total of 37 250 adults with migraine. The majority of participants were female (70% to 100%) and suffering from migraine without aura (14% to 93%). The studies compared oral sumatriptan with placebo or an active comparator. Most of the data were for the 50 mg and 100 mg doses.
- Sumatriptan 50 mg vs. placebo
- With moderate or severe baseline pain (13 studies, n=6447): the NNTs were 6.1, 7.5, and 4.0 for pain-free at two hours and headache relief at one and two hours, respectively. NNTs for sustained pain-free and sustained headache relief during the 24 hours postdose were 9.5 and 6.0, respectively.
- With mild baseline pain (7 studies, n=1514): NNT was 4.4 for pain-free at two hours.
- Sumatriptan 100 mg vs. placebo
- With moderate or severe baseline pain (16 studies, n=6571): the NNTs were 4.7, 6.8 and 3.5, respectively, for pain-free at two hours and headache relief at one and two hours. NNTs for sustained pain-free and sustained headache relief during the 24 hours postdose were 6.5 and 5.2, respectively.
- With mild baseline pain (5 studies, n=1240): NNT was 3.0 for pain-free at two hours.
- Sumatriptan 100 mg vs. sumatriptan 50 mg: 100 mg dose was significantly better than 50 mg dose for pain-free (p=0.0001) and headache relief (p=0.010) at two hours, and for sustained pain-free during 24 hours (p=0.008).
- Sumatriptan 50 mg vs. acetylsalicylic acid 100 mg, rizatriptan 5 mg and rizatriptan 10 mg: there were no significant differences between treatments.
Treating early, during the mild pain phase, gave significantly better NNTs for pain-free at two hours and sustained pain-free during 24 hours than did treating established attacks with moderate or severe pain intensity.Relief of associated symptoms, including nausea, photophobia, and phonophobia, was greater with sumatriptan than with placebo, and use of rescue medication was lower with sumatriptan than with placebo. For the most part, adverse events were transient and mild and were more common with the sumatriptan than with placebo, with a clear dose response relationship (25 mg to 100 mg).
References
- Derry CJ, Derry S, Moore RA. Sumatriptan (oral route of administration) for acute migraine attacks in adults. Cochrane Database Syst Rev 2012;2:CD008615. [PubMed]