Narrowing Down Effective Medications, Classes of Treatments for Migraine: Chia-Chun Chiang, MD

While there are several acute treatments available for migraine, large-scale, head-to-head comparisons of treatment effectiveness is lacking. To fill this unmet need, a group of investigators, led by Chia-Chun Chiang, MD, conducted a real-world comparator study that included 4,777,524 medication-outcome pairs from 3,119,517 migraine attacks among 278,006 users. In total, 25 acute medications among 7 classes were included, with gepant and ditans specifically excluded because of lack of sufficient data at the time of the analysis.

Presented at the 2023 American Academy of Neurology (AAN) Annual Meeting, held April 22-27, in Boston, Massachusetts, the cross-sectional analysis extracted data from an e-diary smartphone application from 2014 to 2020. Using a 2-level nested logistic regression model, triptans (OR, 4.8), ergots (mean OR, 3.02), and anti-emetics (mean OR, 2.67) were the top 3 classes of medications with the highest effectiveness, followed by opioids (mean OR, 2.49), nonsteroidal anti-inflammatory medications (mean OR, 1.94), acetaminophen/acetylsalicylic acid/caffeine(OR 1.69), others(OR 1.49), and acetaminophen(OR 0.83), using ibuprofen as the reference.

Individual medications with the highest ORs were eletriptan (OR, 6.1), zolmitriptan (OR, 5.7), and sumatriptan (OR, 5.2). Chiang, an associate professor of neurology at Mayo Clinic Rochester, sat down at the meeting to discuss these individual statistics, and whether they have an impact on treatment decisions for clinicians. Additionally, she commented on how future data may change with the recent introduction of calcitonin gene-related peptide antagonists.