Evidence based migraine treatments

Finding trustworthy, unbiased and reliable information on migraines is not easy. It can be especially difficult when considering information about treatments.

It’s become easier thanks to the research summaries by providers like Cochrane. An independent, non-profit, evidence-based research collaboration who review clinical trials in healthcare.

Evidence Based Evaluations of Migraine Treatments

Cochrane is a non-profit organisation that provides systematic reviews of scientific research and clinical trials. Stringent guidelines are applied which is why Cochrane Reviews are internationally recognised as one of the highest standards in evidence-based health care reviews.

Below is a table that summarises findings on available evidence for acute migraine treatments.

It's important to remember that they can only review what studies have been conducted. There may be other effective treatments in use, but they may not have been studied in clinical trials.

If the acute medicine you use doesn’t appear below, then it’s because at the time of writing (2015) there were no scientific reviews or clinical evidence for that medicine for the treatment of migraine.

How to read the table

  • The table is ranked from most to least effective in the treatment of acute migraine, sources are listed at the end of the article.
  • % ‘moderate to severe pain’ to ‘no pain’ is measured within a time period of 2 hours. i.e. 59% of those who were given a injection of Sumatriptan in the studies reviewed experienced no pain within 2 hours.
  • % ‘moderate to severe pain’ to ‘mild pain’ is measured within 2 hours.
  • Placebo records number of people who still improved when they were told they were getting the full dose but actually were given a placebo yet they still improved.
  • Data is provided where clinical trials support the treatment. If the acute treatment is not here there are either no trials supporting its efficacy (effectiveness), the trials are not of sufficient scientific rigor or the data is not available.
  • This table does not take into account side effects which may vary by individual.
Migraine medicine treatment table

Key insights

Sumatriptan is found to be one of the most effective migraine treatments. Particularly when delivered as an injection. It is also considerably more expensive in this format.

The majority of patients studied improved 59% from 'moderate or severe' pain to 'no pain' via injection.(1) This fell by almost half when delivered orally. Oral delivery still delivers relief for the significant majority (61%) by reducing moderate/severe pain to 'mild' within 2 hours.(2)

Zolmitriptan delivers comparable results with oral Sumatriptan.(3)

Higher doses of Zolmitriptan were found to deliver slightly better results with 5mg and 10mg. But they were also associated with more adverse events or side effects.(3)

According to the data available, Ibuprofen appears to be most effective NSAID or over the counter medicine to treat migraine.

The 200mg was reported to be only slightly less effective, whilst soluble formulations (i.e. those that dissolve in water) gave quicker responses.(4)

At the bottom of the table is Naproxen. The authors of the study Law, S. Derry S et. al. indicated that “Naproxen is not a good drug for treating migraine at the doses of 500mg or 825mg used in the studies we found.” And that is was only slightly more effective than placebo for relieving migraine headache.(9)

Helping over 90% of the migraine population

If you were to try each of the nine treatments listed in the table separately at the onset of a migraine , statistically speaking there is over a 90% chance of one of these treatments may reduce your pain levels from moderate/severe to nil within 2 hours.

That's +90% of us would experience no pain within 2 hours by one of the above treatments. We just need to try them.

What about those who fall within the small 10% minority?

If all these treatments were tried, 99% would still experience relief from one or more of these treatments ‘from moderate or severe’ to ‘mild pain’ within 2 hours.

If you are a migraine patient and you are not currently experiencing any relief from your migraine treatment it’s time to review the situation with your doctor.

General physicians don’t have time to stay abreast of all the latest research and studies out there. But with a little information, you can prompt discussions with your doctor about what treatments might be most effective for you.

With more research, information and treatments available than ever for migraines there has never been a better time to hope for a brighter future.

This part 1 of a 2 part series. Part 2 will review clinical evidence of preventative treatments for migraine.

What treatments work well for your migraine attacks? Let me know in the comments below.


Sources:

1. Derry CJ, Derry S, Moore RA. Sumatriptan (subcutaneous route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD009665. DOI: 10.1002/14651858.CD009665
2. Derry CJ, Derry S, Moore RA. Sumatriptan (oral route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008615. DOI: 10.1002/14651858.CD008615.pub2
3. Bird S, Derry S, Moore R. Zolmitriptan for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD008616. DOI: 10.1002/14651858.CD008616.pub2
Rabbie R, Derry S, Moore R. Ibuprofen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008039. DOI: 10.1002/14651858.CD008039.pub3
4. Derry CJ, Derry S, Moore RA. Sumatriptan (intranasal route of administration) for acute migraine attacks in adults. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD009663. DOI: 10.1002/14651858.CD009663
5. Kirthi V, Derry S, Moore R. Aspirin with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008041. DOI: 10.1002/14651858.CD008041.pub3
6. Derry S, Rabbie R, Moore R. Diclofenac with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008783. DOI: 10.1002/14651858.CD008783.pub3
7. Derry S, Moore R. Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008040. DOI: 10.1002/14651858.CD008040.pub3
8. Law S, Derry S, Moore R. Naproxen with or without an antiemetic for acute migraine headaches in adults. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD009455. DOI: 10.1002/14651858.CD009455.pub2

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