Comparative Efficacy and Tolerability of Sumatriptan, Ergotamine, Naproxen and Rizatriptan in Moderate to Severe Acute Attack of Migraine

Migraine is a common multifactorial, neurovascular disorder, typically presenting as recurrent disabling attacks of headache, lasting for 4 to 72 hours, associated with nausea, photophobia, phonophobia and transient neurological aura symptoms. WHO recognizes migraine together with quadriplegia, dementia and psychosis as one of the most disabling disorders (1, 2). For the treatment of acute migraine, the most commonly prescribed drugs belong to non-steroidal anti-inflammatory drugs (NSAIDs) and 5-hydroxytryptamine (5-HT) agonist groups. Currently, triptans are considered as specific antimigraine drugs and are evolving as first choice. Still in many countries, ergotamine and NSAIDs are commonly prescribed for the indication and also in many clinical trials NSAIDs have shown equivalent efficacy as triptans for moderate to severe acute migraine (3-13). Against this background, this study aims at evaluating efficacy and safety of commonly prescribed drugs for moderate to severe acute migraine: rizatriptan, sumatriptan, ergotamine compound and naproxen. Materials & Methods The present study was a double blind parallel group study. Patients aging between 16 to 65 years with established diagnosis of migraine with or without aura were included in the study. International Headache Society Diagnostic Criteria were used to define the intensity of migraine as moderate (pain influencing patient's job performance, but he does not miss work) or severe (pain influencing work, school & social situations and he loses time for activities) (14,15). A written informed consent was taken from all the patients. The patients with a history of basilar, ophthalmoplegic or hemiplegic migraine, with organic or structural brain lesion, ischemic heart disease, prinzmetal angina, WPW syndrome, cardiac conduction defect or arrhythmias, uncontrolled hypertension, were excluded. Other exclusion criteria were patients currently on prophylactic medication, pregnancy or amenorrhea, severe renal or hepatic disease and severe vomiting requiring parenteral drug administration. A total of 62 patients were screened, out of which 54 patients fulfilled the inclusion criteria and Abstract A double-blind, randomized, parallel study was done to compare sumatriptan, ergotamine, naproxen and rizatriptan in 40 outpatients treating a single migraine attack of moderate to severe intensity. Among these groups, significantly more number of patients had headache relief at 2 hours postdose in naproxen and rizatriptan group as compared to ergotamine. Naproxen, rizatriptan and sumatriptan were better than ergotamine in causing freedom from the associated symptoms of nausea, vomiting, photophobia and phonophobia at 2 hour postdose. Naproxen, rizatriptan and sumatriptan were also efficacious in causing functional normalization at 2 hours postdose as compared to ergotamine. The overall results of the study suggest that naproxen is as efficacious as triptan group of drugs but better than ergotamine group in treatment of moderate-severe acute migraine attack. It is more cost effective than triptans and also a well tolerated drug