New painkillers less effective (and more expensive) than the 4 triptans

15% of the world’s population suffers from migraine, according to National Institute of Health and Medical Research (Inserm). To treat these headache attacks, several painkillers exist. But, according to a new study published in the journal The British Medical Journal (BMJ), the most recent treatments would be less effective than the old ones, called triptans.

Triptans are the most effective drugs

More than 89,000 people took part in the study, which compared the effectiveness of 17 oral migraine medications. Scientists found that the most effective were four triptans: eletriptan, rizatriptan, sumatriptan and zolmitriptan.

Triptans are a family of drugs that are prescribed in cases of severe migraine attacks, when painkillers are not effective enough. They have been available on the market for several decades. Triptans “act mainly by two mechanisms: a vasoconstrictor effect on the cranial vessels and an inhibitory effect on the release of inflammatory substances”, explains the Vidal.

In detail, the researchers found that eletriptan was most effective at relieving pain after two hours, followed by rizatriptan, sumatriptan, and zolmitriptan. When pain persisted for up to 24 hours, eletriptan and ibuprofen provided more relief.

Migraine painkillers more effective than placebo

“We found that all approved drugs are better than placebo, but some are more effective than other active drugs for the acute treatment of migraine, which is new.“, explains Andrea Cipriani, professor of psychiatry at the University of Oxford and co-author of the study, to the BBC.

In contrast, newer drugs such as ubrogepant, lasmiditan and rimegepant were not as effective as triptans. These drugs in the gepant family are marketed at a higher price than triptans.

According to Andrea Cipriani, triptans remain “largely underutilized“when they should be considered as privileged treatment.”Our findings (..) should be used to help inform future guidelines on acute migraine treatments, to ensure that patients receive the best possible care.”, he says.

But not everyone can take triptans.”These are vasoconstrictors, contraindicated in cases of vascular problems (history of myocardial infarction, angina, stroke, uncontrolled hypertension, etc.), can be read on the website of Inserm. Furthermore, like ergot derivatives (old specific migraine treatments that have fallen out of favor due to their side effects), they prove ineffective in some patients.”