Among menstrual migraine treatments, frovatriptan is best for short-term prevention, while sumatriptan is best for acute pain, according to study results published in The Journal of Headache and Pain.
To assess the relative efficacy of menstrual migraine treatments, researchers performed a systematic review and network meta-analysis by searching PubMed, EMBASE, and Cochrane databases for eligible randomized controlled trials. Researchers also conducted statistical analysis using Stata version 14.0 and evaluated risk for bias in the included studies with the Cochrane Risk of Bias tool for randomized trials version 2 (RoB2). Treatment options for menstrual migraine were assigned to 3 categories: short-term prophylaxis, long-term prophylaxis, and acute treatment.
The study included 14 randomized controlled trials comprising 4601 patients. When used as short-term prophylaxis, taking frovatriptan 2.5 mg twice daily showed the highest likelihood of efficacy (odds ratio [OR], 1.87; 95% CI, 1.48-2.38) compared with the placebo. For acute treatment of migraines, sumatriptan 100 mg was the most efficacious (OR, 4.32; 95% CI, 2.95-6.34) when compared with placebo.
Among several study limitations, many treatment arms were based on one randomized clinical trial, which weakens the validity of the conclusions. The consistency between direct and indirect evidence sources could not be assessed due to the lack of evidence loops. The lack of direct evidence limited the ability to conclude the effectiveness of interventions.
“[W]e observed some discrepancies in the pharmacological response between menstrual migraine and common migraine, implying that the choice of drugs may differ somewhat,” the study authors noted.
Zhang H, Qi JZ, Zhang ZH. Comparative efficacy of different treatments for menstrual migraine: a systematic review and network meta-analysis. J Headache Pain. Published online July 3, 2023. doi:10.1186/s10194-023-01625-x