title: Triptans in the Acute Treatment of Migraine: A Systematic Review and Network Meta-Analysis.
abstract: BACKGROUND
  Although triptans are widely used in the acute management of migraine, there is uncertainty around the comparative efficacy of triptans among each other and vs non-triptan migraine treatments. We conducted systematic reviews and network meta-analyses to compare the relative efficacy of triptans (alone or in combination with other drugs) for acute treatment of migraines compared with other triptan agents, non-steroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid (ASA), acetaminophen, ergots, opioids, or anti-emetics.
  
  
  METHODS
  The Cochrane Library, MEDLINE, and EMBASE were searched for randomized controlled trials that compared triptans (alone or in combination with other drugs) with placebo-controlled or active migraine treatments. Study selection, data extraction, and quality assessment were completed independently by multiple reviewers. Outcome data were combined and analyzed using a Bayesian network meta-analysis. For each outcome, odds ratios, relative risks, and absolute probability of response were calculated.
  
  
  RESULTS
  A total of 133 randomized controlled trials met the inclusion criteria. Standard dose triptans relieved headaches within 2 hours in 42 to 76% of patients, and 2-hour sustained freedom from pain was achieved for 18 to 50% of patients. Standard dose triptans provided sustained headache relief at 24 hours in 29 to 50% of patients, and sustained freedom from pain in 18 to 33% of patients. Use of rescue medications ranged from 20 to 34%. For 2-hour headache relief, standard dose triptan achieved better outcomes (42 to 76% response) than ergots (38%); equal or better outcomes than NSAIDs, ASA, and acetaminophen (46 to 52%); and equal or slightly worse outcomes than combination therapy (62 to 80%). Among individual triptans, sumatriptan subcutaneous injection, rizatriptan ODT, zolmitriptan ODT, and eletriptan tablets were associated with the most favorable outcomes.
  
  
  CONCLUSIONS
  Triptans are effective for migraine relief. Standard dose triptans are associated with better outcomes than ergots, and most triptans are associated with equal or better outcomes compared with NSAIDs, ASA, and acetaminophen. Use of triptans in combination with ASA or acetaminophen, or using alternative modes of administration such as injectables, may be associated with slightly better outcomes than standard dose triptan tablets.
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.|University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Cameron
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Kelly
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Shu-Ching
authors.initials: SC
authors.lastname: Hsieh
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Meghan
authors.initials: M
authors.lastname: Murphy
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kotb
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Peterson
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Becky
authors.initials: B
authors.lastname: Skidmore
authors.affiliation: Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.|CADTH, Ottawa, Canada.
authors.forename: Tammy
authors.initials: T
authors.lastname: Clifford
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.|University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Wells
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D023303:Oxazolidinones / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D058825:Serotonin 5-HT1 Receptor Agonists / Q000627:therapeutic use; D016896:Treatment Outcome; D014363:Tryptamines / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D023303:Oxazolidinones; D058825:Serotonin 5-HT1 Receptor Agonists; D014363:Tryptamines; C089750:zolmitriptan
keywords: benefit; efficacy; migraine; network meta-analysis; systematic review; triptan