MONDAY, Sept. 23, 2024 (HealthDay News) — All active interventions show superior efficacy to placebo for freedom from pain, and most do for sustained pain freedom, for the acute treatment of migraine among adults, according to a review published online Sept. 18 in The BMJ.

William K. Karlsson, from the Danish Headache Centre at Copenhagen University Hospital-Rigshospitalet, and colleagues conducted a systematic review and network meta-analysis to compare all licensed drug interventions as oral monotherapy for acute treatment of migraine episodes in adults. Data were included from 137 randomized controlled trials involving 89,445 participants allocated to one of 17 active interventions or placebo.

The researchers found that compared with placebo, all active interventions showed superior efficacy for pain freedom at two hours (odds ratios from 1.73 for naratriptan to 5.19 for eletriptan), and most also showed superior efficacy for sustained pain freedom to 24 hours (odds ratios from 1.71 for celecoxib to 7.58 for ibuprofen). Eletriptan was the most effective drug for pain freedom at two hours in head-to-head comparisons (odds ratios from 1.46 to 3.01), followed by rizatriptan, sumatriptan, and zolmitriptan (odds ratios, 1.59 to 2.44, 1.35 to 2.04, and 1.47 to 1.96, respectively). The most efficacious interventions for sustained pain freedom were eletriptan and ibuprofen (odds ratios from 1.41 to 4.82).

“The results of this systematic review and network meta-analysis offer the best available evidence to guide the choice of acute oral drug interventions for migraine episodes,” the authors write. “Our results are in line with recent observational evidence.”

Several authors disclosed ties to the biopharmaceutical industry.

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