GPs should prescribe more triptans for the treatment of migraines, say researchers who found them to be the most effective option but underused.
An extensive study by a team across Europe comparing all treatments found triptans to be more effective than newer more expensive drugs and traditional painkillers.
Reporting in the BMJ, the team said guidelines should be updated to reflect that they should be the first option for treatment unless contraindicated.
The study assessed data from 137 randomised controlled trials of almost 90,000 patients and found eletriptan, rizatriptan, sumatriptan, and zolmitriptan were best when efficacy and tolerability were taken into account.
It showed they were also more effective than newer more expensive drugs lasmiditan, rimegepant, and ubrogepant, which were found to be similar to paracetamol and most non-steroidal anti-inflammatory drugs.
All the treatments looked at were found to be better than placebo for pain relief but clinicians had not had the information to help them decide between the different options before now, the researchers said.
Overall, eletriptan was the most effective drug for pain relief at two hours, the researchers said, followed by rizatriptan, sumatriptan, and zolmitriptan.
Having been first developed in the 1990s, triptans are now cheap but underused the researchers noted with rates in Europe varying from 3.4% to 22.5% among people with migraine.
Some patients cannot take them because they cannot tolerate the side effects and they are contraindicated in patients with vascular disease, they added.
Migraine affects more than one billion people worldwide and is the leading cause of disability in girls and women aged 15 to 49 years. Given the findings, triptans should be included into the WHO Model List of Essential Medicines, they concluded.
Study author Professor Andrea Cipriani, professor of psychiatry and director of the Oxford Health Clinical Research Facility, said in recent years the spending on prescriptions for migraine drugs had almost doubled.
‘We need to revise the existing guidelines because at the moment they treat all oral treatments as equally viable options.
‘Our findings pave the way to a precision medicine approach in clinical practice and should be used to help inform future guidelines about treatments for acute migraines to ensure that patients receive the best possible care,’ he added.
Robert Music, chief executive of the Migraine Trust, said: ‘While triptans can be highly effective for some people with migraine, there are many who do not respond to them.
‘Others experience intolerable side-effects or are unable to take them, including those with cardiovascular disease. Frequent use of triptans can also lead to medication overuse headache, which exacerbates the problem.’
