Sumatriptan (subcutaneous route of administration) for acute migraine attacks in
adults.
Author(s): Derry CJ, Derry S, Moore RA.
Affiliation(s): Pain Research and Nuffield Department of Clinical Neurosciences (Nuffield
Division of Anaesthetics), University of Oxford, Oxford,UK.
Publication date & source: 2012, Cochrane Database Syst Rev. , 2:CD009665
BACKGROUND: 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. Subcutaneous administration may be preferable to oral for
individuals experiencing nausea and/or vomiting
OBJECTIVES: To determine the efficacy and tolerability of subcutaneous
sumatriptan compared to placebo and other active interventions in the treatment
of acute migraine attacks in adults.
SEARCH METHODS: We searched Cochrane Central Register of Controlled Trials
(CENTRAL), MEDLINE, EMBASE, online databases, and reference lists for studies
through 13 October 2011.
SELECTION CRITERIA: We included randomised, double-blind, placebo- and/or
active-controlled studies using subcutaneous sumatriptan to treat a migraine
headache episode, with at least 10 participants per treatment arm.
DATA COLLECTION AND ANALYSIS: 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: Thirty-five studies (9365 participants) compared subcutaneous
sumatriptan with placebo or an active comparator. Most of the data were for the 6
mg dose. Sumatriptan surpassed placebo for all efficacy outcomes. For sumatriptan
6 mg versus placebo the NNTs were 2.9, 2.3, 2.2, and 2.1 for pain-free at one and
two hours, and headache relief at one and two hours, respectively, and 6.1 for
sustained pain-free at 24 hours. Results for the 4 mg and 8 mg doses were similar
to the 6 mg dose, with 6 mg significantly better than 4 mg only for pain-free at
one hour, and 8 mg significantly better than 6 mg only for headache relief at one
hour. There was no evidence of increased migraine relief if a second dose of
sumatriptan 6 mg was given after an inadequate response to the first.Relief of
headache-associated symptoms, including nausea, photophobia, and phonophobia, was
greater with sumatriptan than with placebo, and use of rescue medication was
lower with sumatriptan than placebo. For the most part, adverse events were
transient and mild and were more common with sumatriptan than placebo.Sumatriptan
was compared directly with a number of active treatments, including other
triptans, acetylsalicylic acid plus metoclopramide, and dihydroergotamine, but
there were insufficient data for any pooled analyses.
AUTHORS' CONCLUSIONS: Subcutaneous sumatriptan is effective as an abortive
treatment for acute migraine attacks, quickly relieving pain, nausea,
photophobia, phonophobia, and functional disability, but is associated with
increased adverse events.
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