452 Sumatriptan effective for acute migraine in adults

May 01, 2015

written by Brian R McAvoy

Clinical question
How effective is sumatriptan (oral, subcutaneous, intranasal and rectal) in the treatment of acute migraine attack in adults?

Bottom line
Subcutaneous (SC) administration was the most effective route, with pain reduced from moderate or severe to none by 2 hours in 59% of those taking sumatriptan 6mg compared with approximately 15% taking placebo (NNT* 2.3). The most commonly used doses of oral, rectal and intranasal sumatriptan also provided clinically useful pain relief, with the oral 50mg dose providing complete relief of pain in 28% of people compared with 11% after placebo (NNT 6.1). SC administration provided more rapid pain relief than the other routes. Taking medication early, when pain was mild, was more effective than waiting until the pain was moderate or severe. Adverse events were generally of mild or moderate severity, of short duration and more common with SC sumatriptan and higher doses of oral and intranasal sumatriptan than with other dose and route combinations.
*NNT = number needed to treat to benefit one individual.

The vast majority of studies included in each of the 4 reviews specifically treated participants with moderate or severe baseline pain intensity. Only a small number of studies included in the review of oral sumatriptan provided any efficacy data for sumatriptan in participants with mild baseline pain intensity, which may more closely reflect what happens in clinical practice.

Migraine is a highly disabling condition for the individual and also has wide-reaching implications for society, healthcare services and the economy. Migraine affects about 1 person in 8, mainly women, and mainly in the age range of 30 to 50 years. Sumatriptan is an abortive medication for migraine attack and belongs to the triptan family.

Cochrane Systematic Review
Derry CJ et al. Sumatriptan (all routes of administration) for acute migraine attacks in adults – overview of Cochrane reviews. Cochrane Reviews, 2014, Issue 5. Art. No.: CD009108.DOI: 10.1002/14651858. CD009108.pub2. This overview contains 4 reviews covering 111 studies involving 52,236 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.