Some new migraine drugs are no more effective than paracetamol for treating attacks, a major study found.
A cheaper class of medication – known as triptans – were found to be the most effective oral treatment in the comprehensive analysis by Oxford University researchers.
Typically costing around a pound a pill, they beat newer drugs, gepants, in pain suppression during attacks – experienced by up to 190,000 people every day.
Experts said triptans are ‘underused’ and should be made more widely available to millions of sufferers.
But the Migraine Trust said it was often ‘a painful trial and error’ to find what works for individuals and urged doctors not to discount other medications.
An analysis found all drugs were more effective at relieving the pain of a migraine after two hours than the placebo, and the majority eased pain for up to 24 hours.
Scientists looked at 137 controlled trials involving almost 90,000 patients who were given one of 17 drugs or a placebo.
These included triptans; eletriptan, rizatriptan, sumatriptan and zolmitriptan, which constrict blood vessels in the brain and reduce the release of inflammatory chemicals.
A new range of medicines including ubrogepant, atogepant and Rimegepant or ‘gepants’ were also tested, which bind to a protein released by the nerves at the start of a migraine attack.
These can cost up to 12 times as much as triptans, thought to cost around £12 a pill.
All were compared to the likes of paracetamol and anti-inflammatory painkillers for pain relief during an attack.
The analysis found all drugs were more effective at relieving the pain of a migraine after two hours than the placebo, and the majority eased pain for up to 24 hours.
Migraines are estimated to effect almost 10 million UK adults, disproportionately affecting women
Eletriptan to be the most effective for pain relief at two hours, followed by rizatriptan, sumatriptan, and zolmitriptan.
The most effective for pain relief for up to 24 hours were eletriptan and ibuprofen, according to the findings published in the BMJ.
Lead author Andrea Cipriani, a professor of psychiatry at the University of Oxford, said: ‘We found that all the drugs licensed are better than placebo, but some are better than other active drugs for the acute treatment of migraine, which is something new.
‘These drugs are four triptans; eletriptan, rizatriptan, sumatriptan and zolmitriptan. They are more efficacious than the other drugs and also they are better than the most recently marketed and more expensive drugs.’
He added: ‘The efficacy of the new drugs is comparable to paracetamol. They are better than the sugar pill but less than the four triptans.
‘This is important information to consider because of the higher costs of these new treatments.’
Migraines are estimated to effect almost 10 million UK adults, disproportionately affecting women with symptoms including severe headaches, visual disturbances, nausea and vomiting.
Before some people feel a migraine, their vision gets interrupted. This happens as a wave of signals shoot across the brain, like in the pictured diagram. With these signals, a fluid that carries proteins that cause migraine get shunted out of the brain and head to pain receptors
Drugs regulator Nice recommends eletriptan and rizatriptan to treat migraine, and sumatriptan and zolmitriptan to treat migraine and cluster headaches.
It also gave rimegepant the green light last year for up to 145,000 adults where three previous treatments have failed.
Robert Music, chief executive of the Migraine Trust, said triptans ‘can be highly effective for some’ many do not respond to them or are unable to take them due to conditions such as cardiovascular disease.
He said: ‘Finding a migraine treatment that works can be incredibly difficult and can take many years of painful trial and error, the consequences of which can lead to loss of employment, impact on finances and significantly reduced mental health.
‘Our focus should not be deprioritising newer treatments, instead making them more available when people require their use, so that individuals have greater options and choice.’
Dr Eloisa Rubio-Beltran, Migraine Trust Research Associate, said more research was needed to test effectiveness of the drugs against each other in real-world settings.
She said: ‘The involvement of people with lived experience of migraine in the design of this study should set the precedent in the field, and be the norm in future studies.’
