Network meta-analysis of migraine disorder treatment by non-steroidal anti-inflammatory drugs and triptans

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Network meta-analysis of migraine disorder treatment by non-steroidal anti-inflammatory drugs and triptans

Migraine is a moderate or severe headache that occurs as a throbbing pain on one side of the head or sometime both sides, and it is often accompanied by nausea, increased sensitivity to light, vomiting, blurred vision, and emesis Migraine is the 3rd most prevalent and 6th most disabling ailment in the world. However, the prevalence of migraine varies with the age. Females between 35 and 45 years old exhibits the highest prevalence of migraine.

As various treatments have been developed for migraine over the past decades, several disputes have been encountered by clinicians such as inappropriate selection of treatment and medication overuse. Nowadays, medication overuse has become a major issue in chronic migraine patients.  

Two types of therapies developed for migraine include preventive therapies to reduce the frequency of attack or severity and acute therapies which are used for aborting attacks.

Although triptans are popular, NSAIDs remain the recommended option for the treatment of acute migraine and they are often used as an initial strategy for aborting migraine attacks. Triptans are known as rescue medications when other treatments fail to abort the migraine attacks. Studies have suggested that 60% of non-responders to NSAIDs can be treated by triptans.

Despite the fact that both NSAIDs and triptans have been recommended by the European Federation of the Neurological Societies (EFNS) and The American Headache Society (AHS) as acute treatments for migraine, to compare the NSAIDs with triptans is a challenge. A network meta-analysis has been designed to compare the efficacy and tolerability between the NSAIDs and triptans to provide comprehensive evidence with respect to the efficacy and tolerability of these two popular medications.

While considering the multiple pathogenic mechanisms, multi-mechanism-targeted therapy might have better effect than the monotherapy. Triptans not only decreases the transmission of the pain impulses to the trigeminal nucleus caudalis but also release inflammatory mediators from the trigeminal nerves, thereby reducing the calcitonin gene-related peptide-mediated vasodilation.

At last, it can be concluded that eletriptan has proven to be the most suitable therapy for migraine. On the other hand, ibuprofen might also be a good option due to its excellent tolerability. Multi-component medication also attracted the attention and it might be a promising orientation for the next generation of medication for the treatment of migraine.


The Journal of Headache and Pain

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

The Journal of Headache and Pain
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