A COMPARATIVE ANALYSIS OF CLASSICAL TRIPTANS FOR ACUTE MIGRAINE MANAGEMENT

Abstract

Migraine, a prevalent and debilitating neurological condition, necessitates effective acute treatment options. This study undertakes a comparison of the safety and effectiveness of triptans, 5-hydroxytryptamine1F (5-HT1F) receptor agonists, and calcitonin gene-related peptide (CGRP) antagonists using a network meta-analysis and systematic review agonists, and CGRP antagonists in managing acute migraine attacks. Triptans, known for their role in modulating nociception and cranial vasoconstriction, remain primary treatments. Among them, for quick symptom relief, subcutaneous sumatriptan 6 mg proved to be the most effective; eletriptan 80 mg and rizatriptan 10 mg both shown to be more effective than sumatriptan 100 mg. 2.5 mg of naratriptan and 2.5 mg of frovatriptan. While generally well-tolerated, triptans’ side effects and potential for medication overuse headaches limit their long-term utility, and their vasoconstrictive properties pose risks for individuals with cardiovascular conditions. Notably, only a minority of patients achieve complete pain relief within 2 h, and a significant proportion discontinue due to inadequate efficacy or adverse effects. The study highlights the promise of 5-HT1F receptor agonists and CGRP antagonists as viable alternatives, offering effective relief without vasoconstriction. Special populations, including children and pregnant or breastfeeding women, present unique considerations, with sumatriptan being unsuitable for the former and beneficial for the latter. Cost-effectiveness analysis reveals significant regional price variations. In conclusion, while triptans are effective for acute migraine management, their limitations necessitate exploring alternative therapies such as CGRP antagonists and 5-HT1F receptor agonists to improve patient outcomes. To test these alternatives and create all-encompassing treatment plans, more study is needed.