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: 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: 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: