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Review
, 2012 (2), CD008615

Sumatriptan (Oral Route of Administration) for Acute Migraine Attacks in Adults

Affiliations
Review

Sumatriptan (Oral Route of Administration) for Acute Migraine Attacks in Adults

Christopher J Derry et al. Cochrane Database Syst Rev.

Abstract

Background: Migraine is a highly disabling condition for the individual and also has wide-reaching implications for society, healthcare services, and the economy. Sumatriptan is an abortive medication for migraine attacks, belonging to the triptan family.

Objectives: To determine the efficacy and tolerability of oral sumatriptan compared to placebo and other active interventions in the treatment of acute migraine attacks in adults.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, online databases, and reference lists for studies through 13 October 2011.

Selection criteria: We included randomised, double-blind, placebo- and/or active-controlled studies using oral sumatriptan to treat a migraine headache episode, with at least 10 participants per treatment arm.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. We used numbers of participants achieving each outcome to calculate relative risk (or 'risk ratio') and numbers needed to treat to benefit (NNT) or harm (NNH) compared to placebo or a different active treatment.

Main results: Sixty-one studies (37,250 participants) compared oral sumatriptan with placebo or an active comparator. Most of the data were for the 50 mg and 100 mg doses. Sumatriptan surpassed placebo for all efficacy outcomes. For sumatriptan 50 mg versus placebo the NNTs were 6.1, 7.5, and 4.0 for pain-free at two hours and headache relief at one and two hours, respectively. NNTs for sustained pain-free and sustained headache relief during the 24 hours postdose were 9.5 and 6.0, respectively. For sumatriptan 100 mg versus placebo the NNTs were 4.7, 6.8, 3.5, 6.5, and 5.2, respectively, for the same outcomes. Results for the 25 mg dose were similar to the 50 mg dose, while sumatriptan 100 mg was significantly better than 50 mg for pain-free and headache relief at two hours, and for sustained pain-free during 24 hours. Treating early, during the mild pain phase, gave significantly better NNTs for pain-free at two hours and sustained pain-free during 24 hours than did treating established attacks with moderate or severe pain intensity.Relief of associated symptoms, including nausea, photophobia, and phonophobia, was greater with sumatriptan than with placebo, and use of rescue medication was lower with sumatriptan than with placebo. For the most part, adverse events were transient and mild and were more common with the sumatriptan than with placebo, with a clear dose response relationship (25 mg to 100 mg).Sumatriptan was compared directly with a number of active treatments, including other triptans, paracetamol (acetaminophen), acetylsalicylic acid, non-steroidal anti-inflammatory drugs (NSAIDs), and ergotamine combinations.

Authors' conclusions: Oral sumatriptan is effective as an abortive treatment for migraine attacks, relieving pain, nausea, photophobia, phonophobia, and functional disability, but is associated with increased adverse events.

Conflict of interest statement

RAM and SD have received research support from charities, government, and industry sources at various times. RAM has consulted for various pharmaceutical companies, including GlaxoSmithKline, the manufacturers of sumatriptan. RAM has received lecture fees from pharmaceutical companies related to analgesics and other healthcare interventions. CD has no interests to declare. GlaxoSmithKline were not in any way involved in conducting this review.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Forest plot of comparison: 4 Oral sumatriptan 50 mg versus placebo, outcome: 4.1 Pain‐free at 2 h.
3
3
Forest plot of comparison: 4 Oral sumatriptan 50 mg versus placebo, outcome: 4.4 Headache relief at 2 h.
4
4
Forest plot of comparison: 4 Oral sumatriptan 50 mg versus placebo, outcome: 4.5 24 h sustained pain‐free.
5
5
Forest plot of comparison: 4 Oral sumatriptan 50 mg versus placebo, outcome: 4.11 Any adverse event within 24 h.
6
6
Consistency of response: proportion of participants treated with sumatriptan 100 mg achieving headache relief at 2 hours over successive attacks
7
7
Consistency of response: proportion of participants treated with sumatriptan 25 mg or 50 mg experiencing any adverse events within 24 hours over successive attacks (data from Gallagher 2000)
8
8
L'Abbé plot showing results for sumatriptan 50 mg versus placebo for headache relief at 2 hours. Each circle represents a different study; size of circle is proportional to size of study; diagonal is line of equivalence
9
9
L'Abbé plot showing results for sumatriptan 50 mg versus placebo for pain‐free at 2 hours. Each circle represents a different study; size of circle is proportional to size of study; diagonal is line of equivalence
10
10
L'Abbé plot showing results for sumatriptan 50 mg versus placebo for sustained pain‐free during 24 hours. Each circle represents a different study; size of circle is proportional to size of study; diagonal is line of equivalence
1.1
1.1
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 1 Pain‐free at 2 h.
1.2
1.2
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 2 Headache relief at 1 h.
1.3
1.3
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 3 Headache relief at 2 h.
1.4
1.4
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 4 Use of rescue medication.
1.5
1.5
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 5 Relief of associated symptoms.
1.6
1.6
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 6 Relief of functional disability at 2 h.
1.7
1.7
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 7 Any adverse event within 24 h.
1.8
1.8
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 8 Individual adverse events.
1.9
1.9
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 9 Any adverse event withdrawal.
1.10
1.10
Comparison 1 Oral sumatriptan 25 mg versus placebo, Outcome 10 Headache relief at 2 h ‐ effect of quality score.
2.1
2.1
Comparison 2 Oral sumatriptan 25 mg versus rizatriptan 5 mg, Outcome 1 Pain free at 2 h.
2.2
2.2
Comparison 2 Oral sumatriptan 25 mg versus rizatriptan 5 mg, Outcome 2 Headache relief at 1 h.
2.3
2.3
Comparison 2 Oral sumatriptan 25 mg versus rizatriptan 5 mg, Outcome 3 Headache relief at 2 h.
2.4
2.4
Comparison 2 Oral sumatriptan 25 mg versus rizatriptan 5 mg, Outcome 4 Use of rescue medication.
2.5
2.5
Comparison 2 Oral sumatriptan 25 mg versus rizatriptan 5 mg, Outcome 5 Any adverse event within 24 h.
2.6
2.6
Comparison 2 Oral sumatriptan 25 mg versus rizatriptan 5 mg, Outcome 6 Individual adverse events.
3.1
3.1
Comparison 3 Oral sumatriptan 25 mg versus rizatriptan 10 mg, Outcome 1 Pain‐free at 2 h.
3.2
3.2
Comparison 3 Oral sumatriptan 25 mg versus rizatriptan 10 mg, Outcome 2 Headache relief at 1 h.
3.3
3.3
Comparison 3 Oral sumatriptan 25 mg versus rizatriptan 10 mg, Outcome 3 Headache relief at 2 h.
3.4
3.4
Comparison 3 Oral sumatriptan 25 mg versus rizatriptan 10 mg, Outcome 4 Use of rescue medication.
3.5
3.5
Comparison 3 Oral sumatriptan 25 mg versus rizatriptan 10 mg, Outcome 5 Any adverse event within 24 h.
3.6
3.6
Comparison 3 Oral sumatriptan 25 mg versus rizatriptan 10 mg, Outcome 6 Individual adverse events.
4.1
4.1
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 1 Pain‐free at 2 h.
4.2
4.2
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 2 Pain free at 1 h.
4.3
4.3
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 3 Headache relief at 1 h.
4.4
4.4
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 4 Headache relief at 2 h.
4.5
4.5
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 5 24 h sustained pain‐free.
4.6
4.6
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 6 24 h sustained headache relief.
4.7
4.7
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 7 Use of rescue medication.
4.8
4.8
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 8 Relief of associated symptoms in participants with moderate or severe baseline pain intensity.
4.9
4.9
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 9 Relief of associated symptoms in participants with mild baseline pain intensity.
4.10
4.10
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 10 Relief of functional disability at 2 h.
4.11
4.11
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 11 Any adverse event within 24 h.
4.12
4.12
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 12 Individual adverse events.
4.13
4.13
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 13 Any adverse event withdrawal.
4.14
4.14
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 14 Pain free at 2 h ‐ effect of quality score.
4.15
4.15
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 15 Headache relief at 1 h ‐ effect of quality score.
4.16
4.16
Comparison 4 Oral sumatriptan 50 mg versus placebo, Outcome 16 Headache relief at 2 h ‐ effect of quality score.
5.1
5.1
Comparison 5 Oral sumatriptan 50 mg versus effervescent ASA 1000 mg, Outcome 1 Pain‐free at 2 h.
5.2
5.2
Comparison 5 Oral sumatriptan 50 mg versus effervescent ASA 1000 mg, Outcome 2 Pain‐free at 1 h.
5.3
5.3
Comparison 5 Oral sumatriptan 50 mg versus effervescent ASA 1000 mg, Outcome 3 Headache relief at 1 h.
5.4
5.4
Comparison 5 Oral sumatriptan 50 mg versus effervescent ASA 1000 mg, Outcome 4 Headache relief at 2 h.
5.5
5.5
Comparison 5 Oral sumatriptan 50 mg versus effervescent ASA 1000 mg, Outcome 5 Any adverse event within 24 h.
6.1
6.1
Comparison 6 Oral sumatriptan 50 mg versus zolmitriptan 2.5 mg, Outcome 1 Headache relief at 1 h.
6.2
6.2
Comparison 6 Oral sumatriptan 50 mg versus zolmitriptan 2.5 mg, Outcome 2 Headache relief at 2 h.
6.3
6.3
Comparison 6 Oral sumatriptan 50 mg versus zolmitriptan 2.5 mg, Outcome 3 Any adverse event within 24 h.
7.1
7.1
Comparison 7 Oral sumatriptan 50 mg versus zolmitriptan 5 mg, Outcome 1 Headache relief at 1 h.
7.2
7.2
Comparison 7 Oral sumatriptan 50 mg versus zolmitriptan 5 mg, Outcome 2 Headache relief at 2 h.
7.3
7.3
Comparison 7 Oral sumatriptan 50 mg versus zolmitriptan 5 mg, Outcome 3 Any adverse event within 24 h.
8.1
8.1
Comparison 8 Oral sumatriptan 50 mg versus rizatriptan 5 mg, Outcome 1 Pain‐free at 2 h.
8.2
8.2
Comparison 8 Oral sumatriptan 50 mg versus rizatriptan 5 mg, Outcome 2 Headache relief at 1 h.
8.3
8.3
Comparison 8 Oral sumatriptan 50 mg versus rizatriptan 5 mg, Outcome 3 Headache relief at 2 h.
8.4
8.4
Comparison 8 Oral sumatriptan 50 mg versus rizatriptan 5 mg, Outcome 4 Use of rescue medication.
8.5
8.5
Comparison 8 Oral sumatriptan 50 mg versus rizatriptan 5 mg, Outcome 5 Any adverse event within 24 h.
9.1
9.1
Comparison 9 Oral sumatriptan 50 mg versus rizatriptan 10 mg, Outcome 1 Pain‐free at 2 h.
9.2
9.2
Comparison 9 Oral sumatriptan 50 mg versus rizatriptan 10 mg, Outcome 2 Headache relief at 1 h.
9.3
9.3
Comparison 9 Oral sumatriptan 50 mg versus rizatriptan 10 mg, Outcome 3 Headache relief at 2 h.
9.4
9.4
Comparison 9 Oral sumatriptan 50 mg versus rizatriptan 10 mg, Outcome 4 Use of rescue medication.
9.5
9.5
Comparison 9 Oral sumatriptan 50 mg versus rizatriptan 10 mg, Outcome 5 Any adverse event within 24 h.
10.1
10.1
Comparison 10 Oral sumatriptan 50 mg versus eletriptan 40 mg, Outcome 1 Pain‐free at 2 h.
10.2
10.2
Comparison 10 Oral sumatriptan 50 mg versus eletriptan 40 mg, Outcome 2 Headache relief at 1 h.
10.3
10.3
Comparison 10 Oral sumatriptan 50 mg versus eletriptan 40 mg, Outcome 3 Headache relief at 2 h.
10.4
10.4
Comparison 10 Oral sumatriptan 50 mg versus eletriptan 40 mg, Outcome 4 Relief of associated symptoms.
10.5
10.5
Comparison 10 Oral sumatriptan 50 mg versus eletriptan 40 mg, Outcome 5 Relief of functional disability at 2 h.
11.1
11.1
Comparison 11 Oral sumatriptan 50 mg versus eletriptan 80 mg, Outcome 1 Pain‐free at 2 h.
11.2
11.2
Comparison 11 Oral sumatriptan 50 mg versus eletriptan 80 mg, Outcome 2 Headache relief at 1 h.
11.3
11.3
Comparison 11 Oral sumatriptan 50 mg versus eletriptan 80 mg, Outcome 3 Headache relief at 2 h.
11.4
11.4
Comparison 11 Oral sumatriptan 50 mg versus eletriptan 80 mg, Outcome 4 Relief of associated symptoms.
11.5
11.5
Comparison 11 Oral sumatriptan 50 mg versus eletriptan 80 mg, Outcome 5 Relief of functional disability at 2 h.
12.1
12.1
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 1 Pain‐free at 2 h.
12.2
12.2
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 2 Pain‐free at 1 h.
12.3
12.3
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 3 Headache relief at 1 h.
12.4
12.4
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 4 Headache relief at 2 h.
12.5
12.5
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 5 24 h sustained pain free.
12.6
12.6
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 6 24 h sustained headache relief.
12.7
12.7
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 7 Use of rescue medication.
12.8
12.8
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 8 Relief of associated symptoms in participants with moderate or severe baseline pain intensity.
12.9
12.9
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 9 Relief of associated symptoms in participants with mild baseline pain intensity.
12.10
12.10
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 10 Relief of functional disability at 2 h.
12.11
12.11
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 11 Any adverse event within 24 h.
12.12
12.12
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 12 Individual adverse events.
12.13
12.13
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 13 Any adverse event withdrawal.
12.14
12.14
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 14 Headache relief at 2 h ‐ effect of formulation.
12.15
12.15
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 15 Pain‐free at 2 h ‐ effect of quality score.
12.16
12.16
Comparison 12 Oral sumatriptan 100 mg versus placebo, Outcome 16 Headache relief at 2 h ‐ effect of quality score.
13.1
13.1
Comparison 13 Oral sumatriptan 100 mg versus eletriptan 40 mg, Outcome 1 Pain‐free at 2 h.
13.2
13.2
Comparison 13 Oral sumatriptan 100 mg versus eletriptan 40 mg, Outcome 2 Pain‐free at 1 h.
13.3
13.3
Comparison 13 Oral sumatriptan 100 mg versus eletriptan 40 mg, Outcome 3 Headache relief at 1 h.
13.4
13.4
Comparison 13 Oral sumatriptan 100 mg versus eletriptan 40 mg, Outcome 4 Headache relief at 2 h.
13.5
13.5
Comparison 13 Oral sumatriptan 100 mg versus eletriptan 40 mg, Outcome 5 24 h sustained headache relief.
13.6
13.6
Comparison 13 Oral sumatriptan 100 mg versus eletriptan 40 mg, Outcome 6 Use of rescue medication.
13.7
13.7
Comparison 13 Oral sumatriptan 100 mg versus eletriptan 40 mg, Outcome 7 Relief of associated symptoms.
13.8
13.8
Comparison 13 Oral sumatriptan 100 mg versus eletriptan 40 mg, Outcome 8 Relief of functional disability at 2 h.
14.1
14.1
Comparison 14 Oral sumatriptan 100 mg versus eletriptan 80 mg, Outcome 1 Pain‐free at 2 h.
14.2
14.2
Comparison 14 Oral sumatriptan 100 mg versus eletriptan 80 mg, Outcome 2 Pain‐free at 1 h.
14.3
14.3
Comparison 14 Oral sumatriptan 100 mg versus eletriptan 80 mg, Outcome 3 Headache relief at 1 h.
14.4
14.4
Comparison 14 Oral sumatriptan 100 mg versus eletriptan 80 mg, Outcome 4 Headache relief at 2 h.
14.5
14.5
Comparison 14 Oral sumatriptan 100 mg versus eletriptan 80 mg, Outcome 5 Relief of associated symptoms.
14.6
14.6
Comparison 14 Oral sumatriptan 100 mg versus eletriptan 80 mg, Outcome 6 Relief of functional disability at 2 h.
15.1
15.1
Comparison 15 Oral sumatriptan 100 mg versus rizatriptan 10 mg, Outcome 1 Pain‐free at 2 h.
15.2
15.2
Comparison 15 Oral sumatriptan 100 mg versus rizatriptan 10 mg, Outcome 2 Headache relief at 1 h.
15.3
15.3
Comparison 15 Oral sumatriptan 100 mg versus rizatriptan 10 mg, Outcome 3 Any adverse event within 24 h.
16.1
16.1
Comparison 16 Oral sumatriptan 100 mg versus almotriptan 12.5 mg, Outcome 1 Pain‐free at 2 h.
16.2
16.2
Comparison 16 Oral sumatriptan 100 mg versus almotriptan 12.5 mg, Outcome 2 24 h sustained pain‐free.
17.1
17.1
Comparison 17 Oral sumatriptan 100 mg versus paracetamol 1000 mg + metoclopramide 10 mg, Outcome 1 Headache relief at 2 hours.
17.2
17.2
Comparison 17 Oral sumatriptan 100 mg versus paracetamol 1000 mg + metoclopramide 10 mg, Outcome 2 Relief of associated symptoms.
17.3
17.3
Comparison 17 Oral sumatriptan 100 mg versus paracetamol 1000 mg + metoclopramide 10 mg, Outcome 3 Use of rescue medication.
17.4
17.4
Comparison 17 Oral sumatriptan 100 mg versus paracetamol 1000 mg + metoclopramide 10 mg, Outcome 4 Any adverse event within 24 h.
18.1
18.1
Comparison 18 Oral sumatriptan 100 mg versus acetylsalicylic acid 900 mg + metoclopramide 10 mg, Outcome 1 Pain‐free at 2 hours.
18.2
18.2
Comparison 18 Oral sumatriptan 100 mg versus acetylsalicylic acid 900 mg + metoclopramide 10 mg, Outcome 2 Headache relief at 2 hours.
18.3
18.3
Comparison 18 Oral sumatriptan 100 mg versus acetylsalicylic acid 900 mg + metoclopramide 10 mg, Outcome 3 Relief of associated symptoms.
18.4
18.4
Comparison 18 Oral sumatriptan 100 mg versus acetylsalicylic acid 900 mg + metoclopramide 10 mg, Outcome 4 Any adverse event within 24 hours.
19.1
19.1
Comparison 19 Oral sumatriptan 200 mg versus placebo, Outcome 1 Headache relief at 2 h.
19.2
19.2
Comparison 19 Oral sumatriptan 200 mg versus placebo, Outcome 2 Any adverse event withdrawal.
19.3
19.3
Comparison 19 Oral sumatriptan 200 mg versus placebo, Outcome 3 Individual adverse events.
20.1
20.1
Comparison 20 Oral sumatriptan 300 mg versus placebo, Outcome 1 Headache relief at 2 h.
20.2
20.2
Comparison 20 Oral sumatriptan 300 mg versus placebo, Outcome 2 Individual adverse events.

Update of

  • WITHDRAWN: Oral Sumatriptan for Acute Migraine
    DC McCrory et al. Cochrane Database Syst Rev (2), CD002915. PMID 22336784. - Review
    Oral sumatriptan has been shown to be an effective drug for the treatment of a single acute attack of migraine. It is well tolerated, though minor adverse events were not …

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