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Abstract
Objective: To determine whether acute migraine treatment outcome is different in migraine with aura compared with migraine without aura.
Methods: We examined pooled outcome data for sumatriptan treatment of migraine with and without aura from the sumatriptan/naratriptan aggregate patient database. We also examined similar outcome data for inhaled dihydroergotamine (DHE) from a single, large randomized controlled study.
Results: The pooled pain-free rates 2 hours postdose for sumatriptan 100 mg were significantly higher in patients treating attacks without aura (32%) compared with the group who treated attacks with aura (24%) (p < 0.001). The relative risk for pain freedom 2 hours postdose for attacks without aura was 1.33 (95% confidence interval: 1.16–1.54). The number needed to treat for 2 hours of pain freedom was 4.4 for attacks without aura and 6.2 for attacks with aura. For the clinical trial of DHE, the 2-hour pain-free rates did not differ between patients treating attacks without aura (29.4%) compared with those who treated attacks with aura (27.2%; p = 0.65). The relative risk for pain freedom 2 hours postdose for attacks without aura vs with aura was 1.08 (95% confidence interval: 0.77–1.53). The number needed to treat for 2 hours pain free was 5.8 for attacks without aura and 5.0 for attacks with aura.
Conclusion: This post hoc analysis of pooled data from multiple randomized trials indicates that sumatriptan is less effective as acute therapy for migraine attacks with aura compared with attacks without aura. In the single study of inhaled DHE, the treatment had similar efficacy for migraine attacks with and without aura. Different responses of migraine with vs without aura to acute therapies may provide insight into underlying migraine mechanisms and influence the choice of acute therapies for different types of migraine attacks.
GLOSSARY
- DHE=
- dihydroergotamine;
- MA=
- migraine with aura;
- MO=
- migraine without aura;
- NNT=
- number needed to treat;
- RCT=
- randomized controlled trial;
- SNAP=
- sumatriptan/naratriptan aggregate patient
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial, page 1828
- Received April 14, 2014.
- Accepted in final form January 5, 2015.
- © 2015 American Academy of Neurology
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