Network meta-analysis of migraine disorder treatment by NSAIDs and triptans

• Published in: Journal of headache and pain Vol. 17; no. 1; p. 113
• Main Authors: Xu, Haiyang, Han, Wei, Wang, Jinghua, Li, Mingxian
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01-12-2016; Springer Nature B.V
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Humans; Ibuprofen - therapeutic use; Internal Medicine; Medicine; Medicine & Public Health; Meta-analysis; Migraine; Migraine Disorders - diagnosis; Migraine Disorders - drug therapy; Migraine Disorders - epidemiology; Neurological disorders; Neurology; Nonsteroidal anti-inflammatory drugs; Oxazolidinones - therapeutic use; Pain Medicine; Pyrrolidines - therapeutic use; Randomized Controlled Trials as Topic - methods; Research Article; Sumatriptan - therapeutic use; Systematic review; Treatment Outcome; Triazoles - therapeutic use; Tryptamines - therapeutic use; Triptans; Network meta-analysis; Migraine disorders; Non-steroidal anti-inflammatory agents
• ISSN: 1129-2369; 1129-2377
• DOI: 10.1186/s10194-016-0703-0

Background
Migraine is a neurological disorder resulting in large socioeconomic burden. This network meta-analysis (NMA) is designed to compare the relative efficacy and tolerability of non-steroidal anti-inflammatory agents (NSAIDs) and triptans.
Methods
We conducted systematic searches in database PubMed and Embase. Treatment effectiveness was compared by synthesizing direct and indirect evidences using NMA. The surface under curve ranking area (SUCRA) was created to rank those interventions.
Results
Eletriptan and rizatriptan are superior to sumatriptan, zolmitriptan, almotriptan, ibuprofen and aspirin with respect to pain-relief. When analyzing 2 h-nausea-absence, rizatriptan has a better efficacy than sumatriptan, while other treatments indicate no distinctive difference compared with placebo. Furthermore, sumatriptan demonstrates a higher incidence of all-adverse-event compared with diclofenac-potassium, ibuprofen and almotriptan.
Conclusion
This study suggests that eletriptan may be the most suitable therapy for migraine from a comprehensive point of view. In the meantime ibuprofen may also be a good choice for its excellent tolerability. Multi-component medication also attracts attention and may be a promising avenue for the next generation of migraine treatment.