Triptans more effective than NSAID, acetaminophen for acute migraine

The use of triptans and combinations of this drug appears to be better than NSAIDs and acetaminophen alone in relieving pain among individuals with acute attacks of episodic migraine, reports a study.

A team of investigators searched three electronic databases through October 2024, as well as gray literature and reference lists, for eligible English-language randomized trials. They then assessed the risk of bias and certainty of evidence (COE) for each study.

Twenty-one head-to-head and 165 placebo-controlled trials met the inclusion criteria for the meta-analyses, which revealed the superiority of triptans to acetaminophen (low COE) and NSAIDs (high COE) for pain outcomes at 2 h and pain freedom up to 48 h.

In addition, triptan and acetaminophen combinations demonstrated greater efficacy versus acetaminophen alone (moderate COE) for pain outcomes at 2 h and pain freedom up to 48 h, but not more than triptans alone (low COE).

Likewise, triptan combined with NSAIDs was more effective than acetaminophen (low COE), gepants (low COE), NSAIDs (high COE), and triptan monotherapy (moderate COE) for pain outcomes at 2 h and pain freedom up to 48 h.

However, the risk of adverse events was greater with triptan regimens. Moreover, one study reported better cost-effectiveness with triptans than with ditans and gepants.

This study had certain limitations. “Harms assessment was limited to randomized trials, [and] many comparisons lacked sufficient evidence to draw conclusions,” according to the investigators.