Treatment of Migraine Attacks with Sumatriptan
Clinical Question
Is sumatriptan efficacious is treating acute/chronic migraine headaches?
Bottom Line
- Sumatriptan (a 5-HT agonist) is effective therapy for migraine headaches in
patients without underlying coronary, peripheral or cerebral
vascular disease.
The Evidence
Response at 60 minutes
|
Response Rate |
RRR |
ARR (95%CI) |
NNT |
| Placebo |
25% |
- |
- |
- |
| 6 mg dose IM |
72% |
65% |
0.47 (.38-.57) |
2 |
| 8 mg dose IM |
79% |
68% |
0.54 (.43-.65) |
2 |
Response at 120 minutes
|
Response Rate |
RRR |
ARR |
NNT |
| Placebo |
37% |
- |
- |
- |
| 6 mg dose IM |
86% |
57% |
0.49 |
2 |
| 8 mg dose IM |
92% |
60% |
0.55 |
2 |
| 12 mg dose IM |
90% |
59% |
0.53 |
2 |
Comments
- This was a well-conducted RCT.
- The paper was valid on all accounts according to the JAMA guidelines on
therapy articles.
- The results suggest that sumatriptan is superior to placebo in resolving or
reducing the intensity of a migraine attack in select patients. Because of the
nature of the drug, patients with CVD, CAD, PVD, HTN, etc. needed to be excluded
from randomization.
- Side effects included nausea and vomiting, flushing, weakness, drowsiness,
tingling, and pressure sensations. All side effects resolved spontaneously.
- The strength of these results lies primarily in the NNT - only 2 patients
in either the 60 minute or 120 minute evaluation - in order to resolve one
migraine.
- The results and conclusion is applicable and generalizable to your
patients, provided they do not have any of the above listed co-morbidities.
APPRAISED BY: Lorene Siaw, MD
DATE: September, 1995
The subcutaneous sumatriptan international study group. Treatment of
Migraine Attacks with Sumatriptan. NEJM 1991;325:316-321.
