Targeted Review: Medications for Acute Migraine Treatment

ABSTRACT:Objective:To assess the evidence base for drugs used for acute treatment of episodic migraine (headache on < 14 days a month) in Canada.Methods:A detailed search strategy was employed to find relevant published clinical trials of drugs used in Canada for the acute treatment of migraine in adults. Primarily meta-analyses and systematic reviews were included. Where these were not available for a drug or were out of date, individual clinical trial reports were utilized. Only double-blind randomized clinical trials with placebo or active drug controls were included in the analysis. Recommendations and levels of evidence were graded according to the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group, using a consensus group.Results:Eighteen acute migraine medications and two adjunctive medications were evaluated. Twelve acute medications received a strong recommendation with supporting high quality evidence for use in acute migraine therapy (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, ASA, ibuprofen, naproxen sodium, diclofenac potassium, and acetaminophen). Four acute medications received a weak recommendation for use with low or moderate quality evidence (dihydroergotamine, ergotamine, codeine-containing combination analgesics, and tramadol-containing combination analgesics). Three of these medications were NOT recommended for routine use (ergotamine, and codeine- and tramadol-containing medications), and strong recommendations were made to avoid use of butorphanol and butalbital-containing medications. Both metoclopramide and domperidone received a strong recommendation for use with acute migraine attack medications where necessary.Conclusion:Our targeted review formulated recommendations for the available acute medications for migraine treatment according to the GRADE method. This should be helpful for practitioners who prescribe medications for acute migraine treatment.

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Early Responses in Randomized Clinical Trials of Triptans in Acute Migraine Treatment. Are They Clinically Relevant? A Comment

Headache The Journal of Head and Face Pain ◽

10.1111/j.1526-4610.2008.01285.x ◽

2008 ◽

Vol 50 (7) ◽

pp. 1198-1200 ◽

Cited By ~ 5

Author(s):

Peer Tfelt-Hansen

Keyword(s):

Clinical Trials ◽

Randomized Clinical Trials ◽

Migraine Treatment ◽

Acute Migraine ◽

Acute Migraine Treatment

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Acute migraine treatment with droperidol: A randomized, double-blind, placebo-controlled trial

Neurology ◽

10.1212/01.wnl.0000042477.63516.b2 ◽

2003 ◽

Vol 60 (2) ◽

pp. 315-321 ◽

Cited By ~ 84

Author(s):

S.D. Silberstein ◽

W.B. Young ◽

J.E. Mendizabal ◽

J.F. Rothrock ◽

A.S. Alam

Keyword(s):

Controlled Trial ◽

Migraine Treatment ◽

Acute Migraine ◽

Double Blind ◽

Double Blind Placebo ◽

Acute Migraine Treatment

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Rimegepant: acute treatment for migraine headaches

Pain Management ◽

10.2217/pmt-2020-0090 ◽

2021 ◽

Author(s):

Golden L Peters ◽

Erin K Hennessey

Keyword(s):

Migraine Headache ◽

Acute Treatment ◽

Treatment Options ◽

Migraine Treatment ◽

Acute Migraine ◽

The Past ◽

Vasoactive Peptides ◽

Migraine Headaches ◽

Calcitonin Gene ◽

Acute Migraine Treatment

Migraine headache treatment is quickly evolving. There have been three new acute migraine treatment options (i.e., lasmiditan, rimegepant, ubrogepant) and four new preventive migraine treatment options (i.e., erenumab, fremanezumab, galcanezumab, eptinezumab) released in the past 3 years. The new migraine treatments are focusing on pathways within the newly, better understood neurovascular hypothesis that further describes the pathophysiology of migraine headaches in more detail than before. The discovery of vasoactive peptides, such as calcitonin gene-related peptide, has led to the development of many of these migraine agents. Rimegepant is one of these newly approved agents for acute migraine treatment in adults with or without aura. Rimegepant has been found to decrease pain and symptoms associated with migraine attacks and is generally well-tolerated.

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Conduct of Clinical Trials in Acute Migraine Treatment and Their Interpretation

Drug Treatment of Migraine and Other Headaches - Monographs in Clinical Neuroscience ◽

10.1159/000061604 ◽

2000 ◽

pp. 24-29

Author(s):

P. Tfelt-Hansen ◽

B.H. Rasmussen

Keyword(s):

Clinical Trials ◽

Migraine Treatment ◽

Acute Migraine ◽

Acute Migraine Treatment

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Agonist-Like or Antagonist-Like Treatment for Cocaine Dependence with Methadone for Heroin Dependence: Two Double-Blind Randomized Clinical Trials

Neuropsychopharmacology ◽

10.1038/sj.npp.1300392 ◽

2003 ◽

Vol 29 (5) ◽

pp. 969-981 ◽

Cited By ~ 130

Author(s):

John Grabowski ◽

Howard Rhoades ◽

Angela Stotts ◽

Katherine Cowan ◽

Charles Kopecky ◽

...

Keyword(s):

Clinical Trials ◽

Randomized Clinical Trials ◽

Cocaine Dependence ◽

Heroin Dependence ◽

Double Blind

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Efficacy of Long-Acting Injectable Antipsychotic Therapies in Maintenance Treatment of Schizophrenia: A Mixed Treatment Comparison (MTC) of Double-Blind Randomized Clinical Trials

Value in Health ◽

10.1016/j.jval.2013.08.1370 ◽

2013 ◽

Vol 16 (7) ◽

pp. A541

Author(s):

I.M. Majer ◽

F. Gaughran ◽

C. Sapin ◽

M. Beillat ◽

M. Hennequin ◽

...

Keyword(s):

Clinical Trials ◽

Maintenance Treatment ◽

Randomized Clinical Trials ◽

Mixed Treatment Comparison ◽

Double Blind ◽

Treatment Comparison ◽

Mixed Treatment ◽

Long Acting

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What are the reciprocal influences of randomized clinical trials and the patient–psychiatrist relationship?

European Psychiatry ◽

10.1016/s0924-9338(99)80724-x ◽

1999 ◽

Vol 14 (2) ◽

pp. 93-100

Author(s):

J. Catteau ◽

C. Cyran ◽

R. Bordet ◽

C.E. Thomas ◽

B.A. Dupuis

Keyword(s):

Clinical Trials ◽

Depressive Disorders ◽

Randomized Clinical Trials ◽

Antidepressant Drugs ◽

Antidepressant Medication ◽

Study Data ◽

Phase Iii ◽

Double Blind ◽

Phase Iii Clinical Trials ◽

Reciprocal Influences

SummaryThe goal of this prospective investigation was to study the course and the quality of patient-psychiatrist relationships during phase II / phase III clinical trials of antidepressant medication prescribed for depressive disorders. All patients who participated in the clinical trials (and subsequently in this survey) signed written informed consent statements and were subject to random double blind treatment assignment. Retrospective analysis of 118 investigations was carried out, and the patients involved were questioned concerning their experiences and impressions during and after the study. Data show that the outcome of clinical trials of antidepressant drugs are not a function of pre-existing good patient-psychiatrist relationships. On the other hand, no effects on the patient-psychiatrist relationship were found as a result of the experimental procedure, and it can be concluded that no detrimental effects on future patient-psychiatrist relationships were incurred.

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Targeted Review: Medications for Acute Migraine Treatment

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100017832 ◽

2013 ◽

Vol 40 (S3) ◽

pp. S10-S32 ◽

Cited By ~ 2

Author(s):

Irene Worthington ◽

Tamara Pringsheim ◽

Marek J. Gawel ◽

Jonathan Gladstone ◽

Paul Cooper ◽

...

Keyword(s):

Migraine Treatment ◽

Acute Migraine ◽

Acute Migraine Treatment

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Effect of Calcitonin Gene-Related Peptide Receptor Antagonists on Migraine Treatment: A Meta-Analysis

10.21203/rs.3.rs-603934/v1 ◽

2021 ◽

Author(s):

Jiyoung Kim ◽

Kyoungjune Pak ◽

Gha-Hyun Lee ◽

Jae Wook Cho ◽

Hyun-Woo kim

Keyword(s):

Meta Analysis ◽

Calcitonin Gene Related Peptide ◽

Migraine Treatment ◽

Acute Migraine ◽

Cgrp Receptor ◽

Receptor Antagonists ◽

Related Peptide ◽

Calcitonin Gene ◽

Cgrp Receptor Antagonists ◽

Acute Migraine Treatment

Abstract Background: The pathophysiology of migraine has been researched incessantly, and it has been suggested that calcitonin gene-related peptide (CGRP) is associated with migraine attacks. CGRP receptor blockers are attracting attention for migraine prevention and treatment of acute episodes, and CGRP receptor antagonists have been shown to be effective in treating acute migraine headaches. This meta-analysis aimed to assess the effect of available CGRP receptor antagonists, focusing on their therapeutic doses for acute migraine treatment.Methods: We performed a systematic search of MEDLINE (from inception to March 2021) and EMBASE (from inception to March 2021) for English publications using the keywords “migraine” and “Calcitonin gene-related peptide,” limited to human studies.Results: Five studies that focused on examining the effects of CGRP receptor antagonists on acute migraine treatment met the eligibility criteria for this meta-analysis. The pooled analysis demonstrated that the CGRP receptor antagonist improved freedom from pain (OR=2.066, 95% confidence interval [CI] 1.766–2.418, I2=0%), absence of bothersome symptoms (OR=1.606, 95% CI=1.408–1.830, I2=0%), pain relief (OR=1.791, 95% CI=1.598–2.008, I2=0%), and freedom from nausea (OR=1.361, 95% CI=1.196–1.548, I2=0%), significantly more than the placebo. Conclusions: CGRP receptor antagonists are effective for acute migraine treatment and are expected to be used clinically as emerging therapeutic agents.

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