Triptans, a drug usually offered as an alternative to painkillers, have been found to be the most effective medicine for adults who experience acute migraines.

Findings of a study, which recruited over 89,000 participants, compared 17 oral medications commonly used to treat migraines were published recently in The BMJ.

The article “Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis” was led by Professor Andrea Cipriani, Professor of Psychiatry at the University of Oxford and Director of the Oxford Precision Psychiatry Lab and Oxford Health Clinical Research Facility, along with other researchers across Europe.

The article reports findings from the international AMADEUS (Acute Migraine Attacks: Different Effects of individUal drugS) study, which was funded by our Oxford Health Biomedical Research Centre and the Lundbeck Foundation.

Professor Andrea Cipriani said: “The best performing triptans should be considered as the preferred treatment of choice for migraine episodes owing to their ability to induce rapid and freedom from pain.

“Our findings pave the way to a precision medicine approach in clinical practice and should be used to help inform future guidelines about treatments for acute migraines to ensure that patients receive the best possible care.”

Triptans are a group of drugs that are often given as an alternative to painkillers if painkillers do not work. Triptans have a different mechanism of action and work by imitating the action of a brain chemical called 5- hydroxytryptamine, also known as serotonin.

Triptans, specifically eletriptan, rizatriptan, sumatriptan and zolmitriptan demonstrated the highest efficacy for pain relief at two hours and sustained pain relief over 24 hours.

Newer drugs, such as lasmiditan, rimegepant and ubrogepant were compared in the study and were found to be comparable to non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol but were not as effective as triptans.

Ibuprofen also emerged as a strong option for sustained pain freedom up to 24 hours post-dose.

Professor Cipriani said: “Triptans are currently widely underused. Their superior performance of triptans over newer, more expensive, drugs presents a path forward for cost-effective and accessible migraine treatment worldwide.”

Over one billion people worldwide experience debilitating migraines and remains severely under-treated in many parts of the world.