Variety of drugs top ibuprofen for migraine

Triptan, ergot and anti-emetic medications appear to be two to five times more effective than ibuprofen for treating migraine, researchers reported on Nov. 29, 2023 in Neurology.

“There are many treatment options available to those with migraine. However, there is a lack of head-to-head comparisons of the effectiveness of these treatment options,” said study author Chia-Chun Chiang, MD, neurology specialist at the Mayo Clinic in Rochester, Minnesota, “These results confirm that triptans should be considered earlier for treating migraine, rather than reserving their use for severe attacks,” she added.

The investigators conducted a retrospective analysis of data from 3,119,517 migraine attacks during a 6-year period among 278,006 users of an e-diary smartphone application. The app allowed subjects to record migraine frequency, triggers, symptoms and medication effectiveness.

The investigators evaluated the data for the efficacy of 25 acute medications from seven drug classes —  acetaminophen, NSAIDs, triptans, combination analgesics, ergots, anti-emetics, and opioids.

The investigators used this information to compare the efficacy of each drug to ibuprofen.

“Different doses and formulations of each medication, according to the generic names, were combined in this analysis,” they noted.

The study found that the top three classes of medications which were more effective than ibuprofen were triptans, ergots and anti-emetics. Triptans were five times more effective than ibuprofen, ergots were three times more effective and anti-emetics were two and a half times more effective.

In terms of individual drugs, eletriptan which was six times more effective than ibuprofen, zolmitriptan which was five and a half times more effective and sumatriptan which was five times more effective.

Eletriptan was helpful 78% of the time, zolmitriptan was helpful 74% of the time and sumatriptan was helpful 72% of the time.

Ibuprofen was helpful 42% of the time.

Notably, NSAID drugs other than ibuprofen were 94% more effective than ibuprofen, with ketorolac being helpful 62% of the time, indomethacin being helpful 57% of the time and diclofenac being helpful 56% of the time.

Acetaminophen was helpful 37% of the time and was 17% less effective than ibuprofen.

Combination aspirin, acetaminophen and caffeine was 69% more effective than ibuprofen.

The authors concluded. “Our findings that triptans, ergots and anti-emetics are the most effective classes of medications align with the guideline recommendations and offer generalizable insights to complement clinical practice. This study provides Class IV evidence that for patients with migraine, selected acute medications (e.g., triptans, ergots, anti-emetics) are associated with higher odds of user-rated positive response than ibuprofen.”

Chaing added, “For people whose acute migraine medication is not working for them, our hope is that this study shows that there are many alternatives that work for migraine, and we encourage people to talk with their doctors about how to treat this painful and debilitating condition.”