New migraine drugs ‘comparable to paracetamol’, researchers suggest

The effectiveness of new migraine treatments has been compared to paracetamol in a new study, which suggests drugs developed in the 1990s should be more widely promoted to patients with the neurological condition.

Academics hailed certain triptans as the “most effective treatments” for migraine but said they are “underused”.

Experts warned against “deprioritising” newer drugs and instead called for them to be made widely available to give patients more treatment options.

For the study, eletriptan, rizatriptan, sumatriptan and zolmitriptan, also known as triptans, were compared to the likes of paracetamol and anti-inflammatory painkillers, as well as newer drugs such as ubrogepant, atogepant and rimegepant, known as gepants.

Triptans constrict blood vessels in the brain and reduce the release of inflammatory chemicals while gepants work by binding to a protein released by the nerves at the start of a migraine attack.

For the study, researchers looked at 137 controlled trials which tested oral drugs to treat migraine attacks.

The trials involved a total of 89,445 patients who were given one of 17 drugs or a placebo.

They 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.

Lead author Andrea Cipriani, a professor of psychiatry at the University of Oxford, said: “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.”

In England, the National Institute for Health and Care Excellence (Nice) recommends eletriptan and rizatriptan to treat migraine, and sumatriptan and zolmitriptan to treat migraine and cluster headaches.

In terms of the newer treatments, Nice gave rimegepant the green light for NHS use last September for patients who have tried at least two triptans.

Prof Cipriani added: “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.

“The efficacy of the new drugs is comparable to paracetamol. They are better than the sugar pill but less than the four triptans.

“This is important information to consider because of the higher costs of these new treatments.”

About one billion people worldwide suffer from migraine attacks, according to Prof Cipriani.

The Migraine Trust estimates about 10 million people in the UK live with the neurological condition.

Among the symptoms are intense headaches, sensitivity to light, visual disturbances, nausea and vomiting.

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.”