Zolmitriptan

21 October 2024

Oxford Report on the “Best” Medications – Takeaways…

James Discoveries & Stats, Medications, News, Tips 0

Led by researchers at the University of Oxford, and published in the British Medical Journal, a new study compares migraine medications to find out which is “best”.

Well, they would not phrase it that way. Really, they were trying to judge which medications had the best results in good clinical trials. This is important, because information like this can tell doctors which medication they might want to try with “person X”.

But, of course, there is no “person x”. When a specialist recommends a medication, they should be aware of your medical history, symptoms, and even family history. Study co-author Elena Ruiz de la Torre said it well – “Migraine is a very personal disease”. As also quoted at NewScientist, migraine expert Dr. Peter Goadsby adds that these studies “tell you about a population, but they’re very blunt instruments for trying to understand what’s going on at an individual level.”

With that warning in mind, it is still helpful to have these studies, and here’s what they found.

The now “older” migraine medications, the triptans, are still great tools. In fact, in these studies they are beating out the newer CGRP related medications such as lasmiditan, rimegepant, and ubrogepant.

So the report gave great marks especially to eletriptan, and after that rizatriptan, sumatriptan, and zolmitriptan. Interestingly enough, the humble ibuprofen also got high marks in this report.

In other words, these were the medications that had the best evidence for getting rid of pain and having few side effects.

Again, remember that the newer drugs are helping people that did not respond well to the triptans. And there may be medications and treatments that are better for treating certain people with certain symptoms.

The authors summarize their conclusion based on the studies they reviewed:

Results on both benefits and harms should inform shared clinical decision making, considering the preferences of patients, caregivers, and healthcare professionals. Our findings should help inform future guidelines and updates to recommendations to ensure that patients receive optimal care. Overall, the results of our network meta-analysis suggest that the best performing triptans should be considered the treatment of choice for migraine episodes owing to their capacity for inducing rapid and sustained pain freedom, which is of key importance for people with migraine. While the recent introduction of lasmiditan, rimegepant, and ubrogepant has expanded options for the acute treatment of migraine, the high cost of these newer drugs, along with the substantial adverse effects of lasmiditan, suggest their use as third line options, after the less expensive, similarly efficacious, second line options such as ibuprofen, acetylsalicylic acid, diclofenac potassium, almotriptan, and frovatriptan have been considered.
Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis

So the moral of the story? The general guidelines out there don’t seem to be far off, and this is no time to throw out the old just because we have the new. All things equal, if you’re thinking of trying a medication for migraine, talk to your doctor about the triptans. But be sure your doctor knows your situation. You are not “person x”.

Also see: Major study suggests best treatments for migraines

And from earlier this year: “Older” Migraine Meds on Trial: What Works?

And back to ibuprofen – NSAIDs – Which One Should I Take For Headache?

5 January 2024

“Older” Migraine Meds on Trial: What Works?

James Discoveries & Stats, Medications 0

Late last year a new study analyzed almost 4.7 million migraine attacks and the medications that patients took. According to those patients, which abortive medications actually worked?

The data was collected from patients’ responses on a smartphone app between 2014 and 2020 (which is why newer medications like gepants and ditans were not included in the study). Dosage was also not taken into consideration. Finally, the “baseline” was ibuprofun. In other words, which medications worked better than (or not as well as) ibuprofen?

However, as you can see, the sample size was huge. So which medications, according to patients, really fought back against an individual migraine attack?

It shouldn’t surprise too many that the migraine-targeting meds worked best:

Triptans (e.g. eletriptan, sumatriptan, zolmitriptan) were at the top of the list, working well 5x more often than ibuprofen.
Ergots (dihydroergotamine and ergotamine) were 3x more effective than ibuprofen
Anti-emetics (anti-nausea medications) were 2.5x more effective
Next came opioids, and NSAIDs (not including ibuprofen)

This is not to say that ibuprofen isn’t effective. It was still effective 42% of the time. And it roundly beat acetaminophen (paracetamol), which was effective 37% of the time.

But other similar NSAIDs other than ibuprofen may be worth trying – especially ketorolac, which came out as working 62% of the time, significantly more than its cousin ibuprofen.

Since triptans topped the list, which triptans tended to work the best? Well, it was the ones listed above, but not in that order:

eletriptan
zolmitriptan
sumatriptan

They were all considered effective over 70% of the time – and remember, triptans very much depend on the person, and also how they’re taken.

There’s no doubt that these “older” medications, even ibuprofen, are still helping a lot of people. Lists like this won’t necessarily tell you what will work for you. However, they do give you a place to start.

Your doctor will be able to take more of your personal medical history into consideration when recommending a medication. And there are also risks and side effects to consider, which also vary from person to person.

But if you’re a candidate for a triptan, one of the top three is probably going to be high on your doctor’s list. Tylenol, on the other hand, might be best left on the drugstore shelf, until you’ve tried some better options for migraine.

For the actual study abstract, you can go to Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users’ Self-Reported Records From a Smartphone Application.

For another more detailed analysis, check out Certain Migraine Medications May Be More Effective Than Ibuprofen.

8 May 2020

Which Medications are most recommended for Children and Teens with Migraine?

James Discoveries & Stats, Medications 0

These specific recommendations come from the American Academy of Neurology and the American Headache Society. A helpful summary was published at Practical Pain Management.

As with many such studies, the recommendations come from the level of “confidence” that we have based on the results of clinical trials. For example, as we’ll see under “preventatives”, amitriptyline (Elavil) is “high confidence” as a preventative, but propranolol (Inderol) is “low confidence”. That doesn’t necessarily mean that amitriptyline is amazing and the best or that propranolol is useless. It does mean that our data for propranolol is a lot more limited – although so far it looks quite promising.

Before even getting to medication, the article (Ask the PharmD: What are the recommendations for preventing and treating pediatric migraine?) quite rightly points to lifestyle changes. We could add to that other treatments, including biofeedback and certain supplements. It’s tempting to look at the most recommended medications and think that these are the most recommended treatments – that’s not the case. With children, as with adults, there are some excellent treatments that you’ll probably want to try before any regular medications (especially preventative medications).

So let’s start with abortive medications – which drugs are most recommended to stop a migraine attack once it’s started? Remember, this is different with every child, but at this point the most recommended include triptans – but not any triptan. Most recommended are zolmitriptan, and then sumitriptan. Also the combination of sumitriptan and naproxen. However, these are only recommended for ages 12 and up (many medications simply haven’t been adequately studied in younger children).

Ibuprofen is also recommended, and is the #1 choice for younger children (6 months and older).

Sumitriptan/noproxen and zolmitriptan were also recommended for the related symptoms of photophobia and phonophobia – that is, sensitivity to light and noise.

If the symptoms are serious and frequent, and other medications haven’t worked sufficiently, preventatives may be tried.

For preventatives, as mentioned earlier, amitriptyline was the “high confidence” choice, with topiramate sneaking in under “moderate confidence”. These were only listed for ages 10-17.

Remember, preventatives should be far down the list of things to try. Steady doses of medication and their side effects are not to be rushed into. Check this article for other reasons to be less than optimistic about preventatives for children: New Study Questions Preventative Migraine Drugs for Kids

Remember, these recommendations do not automatically mean that they’re the best choice for you or your child. If other medication has been tried but these have not, it’s probably a good place to start. But it will be worth the trouble to investigate other non-drug treatments, many of which have been very helpful for children and teens.

For more details, take a look at the article at Practical Pain Management, especially the last section.

9 October 2017

Coming Soon: The “ADAM” System for Zolmitriptan

James Uncategorized 0

Triptan medications have helped a lot of people with both migraine and cluster, and as the technology and research improves, more people who can benefit are able to use them.

Zolmitriptan in particular has been useful for both migraine and cluster headache, even for children with cluster headache.

A new delivery system for zolmitriptan is being tested under the drab name of M207, but also using the magnificent name The Adhesive Dermally Applied Microarray (ADAM) Zolmitriptan System.

Most of that simply means that it’s a sticker or patch. “Microarray” actually refers to a system of tiny needles – a word that is understandably avoided. Actually, from what I’ve heard so far, most patients do not experience pain from this patch (some of you who have been in the trials may want to comment).

How does it work? You take a small unit and apply the small round patch to your arm (it kind of reminds me of one of those bingo daubers – but of course it applies a sticker in this case). The patch gets the medication into your system very quickly – which is the main point.

ADAM System for Zolmitriptan - Application

ADAM System for Zolmitriptan - Applied For both migraine and cluster headache, you want the medication to get into your system as efficiently and quickly as possible. Many people have not benefited from zolmitriptan simply because they’ve taken it orally – and the medicine hasn’t gotten to where it needs to go on time – if ever.

So far the results have been good. Many patients have experienced full relief within an hour, more than half within three hours. This is with a dose of 3.8mg.

These results tell us that most people should benefit, but more importantly a few people should experience significant relief very quickly.

We’re talking about cluster headache, even though that is not the focus of the current trials. Finding better ways to administer this medication should help people with cluster as well, so we’ll watch for future developments.

There will be a new trial of the ADAM System for Zolmitriptan opening soon for adults with episodic migraine. The trial will investigate safety over 12 months, and see how the patch does in treating other symptoms such as nausea, photophobia and phonophobia.

If you’re interested in the trial, find out more here: A Study to Evaluate the Long-Term Safety of M207 in the Acute Treatment of Migraine (ADAM)

20 June 2016

Yes, Children Get Cluster Headache Too

James Information, Resources, Treatments 2

Although cluster headache usually starts in your 20s or 30s, children can, and do, get cluster too. Usually the symptoms start after the age of 10, but children with cluster have been reported as young as 6 years old.

The fact that cluster headache is extremely rare in children is no comfort to children who get it and their families who are trying to help them. Although we’ve talked about cluster headache in children before, it’s time for an update.

As with adult cluster, more males are diagnosed than females. However, a surprising number of girls get cluster as well.

But one of the biggest challenges is diagnosis. A study in 2009 of eleven children found that, on average, their symptoms began at the age of 8.5, but they went two years without a proper diagnosis.

Sadly, headaches in children are often considered to be caused by “stress” or “attitude”. However, a specialist who know what questions to ask can get to the truth a lot faster.

Another challenge is that cluster headache is not usually constant. Attacks typically last from 15 minutes to three hours. But they also go into remission. Headaches may occur once or several times a day for a while, and then disappear for months or years.

Symptoms in children tend to be similar to those in adults. That would include agitation and restless movement, one sided pain, congestion, and facial flushing and sweating. (For more detail, see Cluster Headache Symptoms)

Treatments for cluster are also similar to treatments in adults, partly because precious little study has been done specifically for children. One study found that oxygen, methysergide, verapamil, zolmitriptan and dihydroergotamine were particularly helpful for children, but that paracetamol/acetaminophen, ibuprofen and codeine with paracetamol/acetaminophen were not particularly helpful.

For more information: