Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment: a meta-analysis of 53 trials

Oral triptans, serotonin 5-HT(1B/1D) agonists, are effective acute migraine treatments. Seven types of triptans will soon be available, necessitating evidence-based selection guidelines. We analyzed data from 53 clinical trials involving 24,089 patients. The trials included both published and unpublished studies. Most trials had similar designs, allowing for effective meta-analysis. For 100 mg sumatriptan, 59% experienced a two-hour headache response. Additionally, 29% reported being pain-free within two hours. Sustaining pain-free status was achieved by 20%, and 67% showed consistent response rates. Adverse events occurred in 13% of patients, with central nervous system events in 6%. Rizatriptan showed better efficacy and consistency compared to sumatriptan. Eletriptan had higher efficacy but lower tolerability. Almotriptan had similar efficacy at two hours but better overall results. Overall, all triptans were effective and well tolerated, with three specific types showing the best outcomes. Clinical relevance: This research highlights which triptans provide the most effective and consistent relief for migraine sufferers.