Most effective migraine drug named as new review brings hope to suffering Brits (original) (raw)

Oxford University scientists reviewed 89,000 patients in clinical trials given 17 different pills for migraine attacks and identified which were the most effective

Scientists reveal best pills for reducing the pain of a headache

The most effective drugs for tackling the pain of migraines has been revealed after a major review.

Oxford University scientists reviewed 89,000 patients given one of 17 different pills to treat migraine attacks or a placebo in 137 controlled trials.

Prescription painkillers called triptans came out top, performing better than newer, more expensive drugs, and scientists say they are being underused. The review has sparked calls for the drugs, developed in the 1990s, to be more widely promoted to patients by GPs.

Around 10 million people in the UK suffer some form of migraines including three-times as many women as men, likely due to the differences in sex hormones.

Triptans constrict blood vessels in the brain and reduce the release of inflammatory chemicals. They come in four different forms; eletriptan, rizatriptan, sumatriptan and zolmitriptan. They were compared to the likes of paracetamol and anti-inflammatory painkillers, as well as newer drugs known as gepants.

Lead author Prof Andrea Cipriani said: "We know that triptans are underused across the world. Allowing access to these four most effective treatments should be promoted globally, and also implemented into the international guidelines, which should be updated accordingly.”

Eletriptan was the most effective for pain relief at two hours followed by rizatriptan, sumatriptan, and zolmitriptan.

The review found all drugs were more effective at relieving the pain of a migraine after two hours than the placebo, and the majority provided pain relief for up to 24 hours. When comparing the drugs, researchers found eletriptan to be the most effective for pain relief at two hours, followed by rizatriptan, sumatriptan, and zolmitriptan. The most effective for pain relief for up to 24 hours were eletriptan and ibuprofen.

Prof Cipriani added: “We found that all the drugs licensed are better than placebo, but some are better than other active drugs for the acute treatment of migraine, which is something new. These drugs are four triptans; eletriptan, rizatriptan, sumatriptan and zolmitriptan. They are more efficacious than the other drugs and also they are better than the most recently marketed and more expensive drugs."

Dr Eloisa Rubio-Beltran, expert at King’s College London, who was not involved in the research, said: “Due to their high efficacy and low cost, triptans should be the first-line treatment option for the acute treatment of migraine.”

It is estimated that up to 43 million workdays are lost each year in the UK to migraine-related absenteeism. Migraines are estimated to cost the UK economy between £6 billion and £10 billion a year in healthcare and productivity costs.

Different pills work for different patients, experts say

The review comes after a newer form of migraine drugs became available in recent years called gepants. They work by binding to a protein released by the nerves at the start of a migraine attack. Types of gepants tested were ubrogepant, atogepant and rimegepant. The National Institute for Health and Care Excellence (Nice) gave rimegepant the green light for NHS use last September for patients who have tried at least two triptans.

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.

"Finding a migraine treatment that works can be incredibly difficult and can take many years of painful trial and error, the consequences of which can lead to loss of employment, impact on finances and significantly reduced mental health.

"Our focus should not be deprioritising newer treatments, instead making them more available when people require their use, so that individuals have greater options and choice."