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Neurol Sci. 2018 Jan;39(1):31-44. doi: 10.1007/s10072-017-3119-y. Epub 2017 Sep 23.

Intranasal sumatriptan for acute migraine attacks: a systematic review and meta-analysis.

Menshawy A1,2,3, Ahmed H2,4,5, Ismail A1,2,6, Abushouk AI7,8,9, Ghanem E1,2, Pallanti R1,10, Negida A2,4,5.

Author information

1
Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
2
Medical Research Group of Egypt, Cairo, Egypt.
3
Al-Azhar Medical Students' Association (AMSA), Cairo, Egypt.
4
Faculty of Medicine, Zagazig University, El Sharkia, Egypt.
5
Student Research Unit, Zagazig University, El Sharkia, Egypt.
6
NovaMed Medical Research Association, Cairo, Egypt.
7
Medical Research Group of Egypt, Cairo, Egypt. Abdelrahman.Abushouk@med.asu.edu.eg.
8
NovaMed Medical Research Association, Cairo, Egypt. Abdelrahman.Abushouk@med.asu.edu.eg.
9
Faculty of Medicine, Ain Shams University, Ramsis St, Cairo, 11591, Egypt. Abdelrahman.Abushouk@med.asu.edu.eg.
10
Osmania College of Medicine, Hyderabad, India.

Abstract

We performed this systematic review and meta-analysis to evaluate the tolerability and efficacy of intranasal sumatriptan, a selective serotonin agonist, compared to placebo or other migraine therapeutics for the treatment of acute migraine attacks. We searched PubMed, SCOPUS, Embase, and Cochrane CENTRAL for relevant randomized controlled trials (RCTs). Data were extracted from eligible studies and pooled as risk ratios (RR), using RevMan software. We performed subgroup and meta-regression analyses for different doses and treatment endpoints. Sixteen RCTs (n = 5925 patients) matched our inclusion criteria. The overall effect-estimate showed that intranasal sumatriptan was superior to placebo in terms of pain relief (RR = 1.70, 95% CI [1.31, 2.21], p < 0.0001) and headache relief (RR = 1.58, 95% CI [1.35, 1.84], p < 0.00001) at 2 h. Although sumatriptan was superior to placebo in terms of headache relief at 30 min (RR = 1.31, 95% CI [1.08, 1.59], p = 0.005), no significant difference was found between both groups in terms of the frequency of pain-free participants at 30 min (RR = 1.18, 95% CI [0.49, 2.88], p = 0.71). Subgroup analysis and meta-regression models showed that increasing the dose of sumatriptan reduced the time needed for headache relief; however, this clinical improvement with higher doses was associated with more frequent adverse events in comparison to smaller doses. In conclusion, intranasal sumatriptan is effective for the treatment of acute migraine attacks. However, it was associated with a six-fold increase in the risk of taste disturbance, compared to the placebo. Future RCTs are recommended to provide head-to-head comparison of different administration routes and drug formulations of sumatriptan.

KEYWORDS:

Headache; Intranasal; Meta-analysis; Migraine; Sumatriptan

PMID:
28942578
DOI:
10.1007/s10072-017-3119-y
[Indexed for MEDLINE]

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