Treatment of Migraine Attacks with Sumatriptan

Due to its prevalence and severe symptoms, migraine headache is among the world’s leading cause of disability. Before the 1990s, abortive therapy for migraine headaches was largely dependent on simple analgesics, antiemetics, and dihydroergotamine (DHE). It was around this time that physicians gained a better understanding of the pathophysiology of migraine headaches and developed a new class of abortive therapies, triptans. There are now many different triptans that are FDA-approved for migraine headaches, but sumatriptan was the first one that marked a new era in migraine pharmacotherapy.

In 1991, the Subcutaneous Sumatriptan International Study Group conducted a randomized, double-blind, placebo-controlled, parallel-group clinical trial to compare the efficacy of 6 or 8 mg subcutaneous sumatriptan to placebo. This study recruited 639 patients into three treatment groups: 6 mg sumatriptan, 8 mg sumatriptan, and placebo.

Inclusion criteria included patients in the age range 18 to 65 with at least 1-year history of migraine (per Internation Headache Society migraine classification) and a maximum headache frequency of 6 per month. Exclusion criteria were extensive and included patients with cardiovascular comorbidities, cerebrovascular risk factors, and psychiatric comorbidities, as well as those who required regular use of opioids or ergot-containing drugs.

The treatment effect was measured on a four-point symptom severity scale at 30, 60, and 120 minutes after therapy. Patients who could not achieve symptom resolution by 60 minutes, received a second double-blind therapy; the initial placebo and 8 mg sumatriptan groups received a placebo treatment, while the 6 mg sumatriptan group received either a placebo or another 6 mg of sumatriptan.

At 60 minutes, the headache severity was decreased in 72% (95% CI 68-76) of patients in the 6 mg sumatriptan group, and 79% (95% CI 71-87) of patients in the 8 mg sumatriptan group. Only 25% (95% CI 17-33) of patients in the placebo group had symptom improvement at 60 minutes.

After 120 minutes, reduced headache severity was achieved in 86-92% of the sumatriptan-treated groups and only in 37% of the placebo group (p< 0.001 for all comparisons). The study group concluded that subcutaneous sumatriptan injection is a highly effective, well-tolerated treatment for migraine attacks.

Since this study, several other triptan formulations, as well as routes of administration (oral, nasal, rectal) have been approved for migraine headaches. Despite this, sumatriptan remains one of the most commonly used triptans!

Feel free to review the landmark article here!