Triptan drugs found to be more effective against migraines than newer ones

Triptan class of drugs are more effective in treating migraine headaches, compared to newer and more expensive drugs, an analysis of nearly 140 clinical trials, involving about 90,000 participants, has suggested.

The analysis, published in The British Medical Journal, showed that eletriptan, rizatriptan, sumatriptan, and zolmitriptan were better in relieving pain than the relatively recently developed drugs—lasmiditan, rimegepant, and ubrogepant. All these drugs are marketed in India.

Commercially available since the 1990s, triptan drugs work by changing how blood is circulated in brain and by silencing overactive pain nerves, they change how pain is processed.

While numerous antimigraine drugs are available, researchers, including those from Copenhagen University Hospital in Denmark, said that there is clear consensus as to which performs best in treating the neurological condition affecting more than a billion around the world. It is also the leading cause of disability or poor health in girls and women aged 15-49 years.

The researchers said that triptans are widely underused and added that they should be “considered the treatment of choice for migraine episodes, owing to their capacity for inducing rapid and sustained pain freedom.”

While some of the triptan class of drugs have been studied to lower menstrual migraines too, which can be more severe and last longer than non-menstrual migraines, women should be cautious and avoid overuse, according to the American Migraine Foundation.

The authors called for an improved access to triptan drugs worldwide by including them into the WHO Model List of Essential Medicines, along with updating international clinical guidelines for diagnosing and managing migraines.

For the study, the researchers identified a total of 137 randomised controlled trials, published up to June 24, 2023, and comprising 89,445 participants—who were aged 40 years on average and 86 per cent of whom were women.

“When the active interventions (drugs) were compared with each other, eletriptan was superior to almost all the other drugs for achieving pain freedom at two hours, followed by rizatriptan, sumatriptan, and zolmitriptan,” the authors wrote.

Further, among the triptan drugs, eletriptan was found to be the most effective in bringing about a sustained freedom from pain for up to 24 hours.

The researchers said that the results “offer the best available evidence to guide the choice of acute oral drug interventions for migraine episodes.”