The Most Effective Medications for Acute Migraines: Patient Perspectives

Researchers analyzed 10 842 795 migraine attack records obtained from an e-diary smartphone app, which recorded whether the treatment was helpful, somewhat helpful, unsure, or unhelpful. The effects of 25 medications commonly used for the acute management of MH among 7 classes were studied: triptans, opioids, acetaminophen, NSAIDs, ergots, antiemetics, and combination analgesics (acetaminophen/acetylsalicylic acid/caffeine).

The individual medications that were found to be most effective were 3 triptans: eletriptan, zolmitriptan, and sumatriptan.

The findings indicate that of the MH medications available when the study was performed, triptans followed by ergots and antiemetics were the most effective according to the self reports of participants and, barring contraindications, should be tried first before proceeding to other medications.

Although several medications provided benefits for the greatest number of participants, other participants reported responding to the other medications studied. Thus, we are still left with the issue of which medication an individual patient is most likely to respond to.

Because the study was based on information obtained from 2014 to 2020, it did not include 2 of the newest classes of medication now available for the management of migraines: calcitonin gene-related peptide receptor antagonists (gepants) or 5-HT1F receptor agonists (ditans). Further studies will be required to determine how their efficacy compares with those of the medications examined in the study.

An important issue that the study did not address was whether the effectiveness of each medication was the same for both MH with aura and without aura. As many headache specialists consider these 2 separate syndromes with possibly different etiologies, it would be helpful to know if the same treatments were as effective for both.