The use of combination therapies in the acute management of migraine

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The use of combination therapies in the acute management of migraine

Migraine is a highly prevalent disorder manifesting clinically as headache attacks of moderate to severe intensity. Migraine attacks generally induce a great deal of disability among its sufferers. It is a complex condition with a wide variety of symptoms.

Women are two to three times more likely to develop migraine and is most common in the age range 30 to 50 years. Recently, the role of combining agents for acute migraine treatment has gained attention and the combination of triptan and non-steroidal anti-inflammatory drug (NSAID) has demonstrated better efficacy. Sumatriptan and naproxen combination was useful to treat acute migraine attacks.

Researchers looked for clinical trials from 1946 to 28 October 2015 using sumatriptan plus naproxen to treat migraine headache in adults and the objective of study was to determine the efficacy and tolerability of sumatriptan plus naproxen. People were given either a combination of sumatriptan and naproxen, sumatriptan only, naproxen only or taken as a fixed-dose combination tablet, or a placebo treatment. They did not know which treatment they were taking and nor did the health professionals looking after them.

This review found 13 studies using sumatriptan 85 mg or 50 mg plus naproxen 500 mg to treat attacks of mild, moderate, or severe pain intensity. Out of these, 12 studies provided information on how well the combination treatment worked. Overall, the combination of sumatriptan plus naproxen was better than placebo for relieving acute migraine attacks at two hours in adults.

The starting headache intensity was mild, 50% response noticed in participants treated with sumatriptan plus naproxen were pain-free at two hours as compared to 18% with placebo. Almost 28% people with moderate or severe pain who were treated with combination had pain reduced to mild or none at 2 hours as compared with 27% response with placebo. However, 50 mg of sumatriptan, rather than 85 mg, in the combination did not significantly change the result.

Researchers revealed that the combination of sumatriptan plus naproxen was useful for treating migraine attacks in the studies. It was not a lot better than using sumatriptan alone, but it was much better than using naproxen alone. Attacks were more successfully treated when medication was taken early and pain was mild. Adverse events were more common with sumatriptan (alone or in combination) than with placebo or naproxen.

Cochrane Database Syst Rev
Therapeutic, Sumatriptan, Naproxen, Migraine, Head, Triptan, NSAIDs, Randomised, double-blind, placebo- or active-controlled studies, Efficacy, Safety, Tolerability, NNT for pain, Dizziness, Tingling, Burning of the skin, Sleepiness, Nausea, Indigestion, Dry mouth, Chest discomfort, Orally
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