Treatment Implications of Trigeminal Sensitization in Acute and Chronic Migraine: Expert Commentary on Selected Abstracts

Abstract

OBJECTIVE: To evaluate the efficacy and tolerability of sumatriptan, 50-mg and 100-mg tablets, compared with the placebo for the treatment of migraine at the first sign of pain.

PATIENTS AND METHODS: Two identical multicenter randomized, double-blind, placebo-controlled, single-attack studies were conducted from May through November 2000 in adults (aged 18–65 years). Patients treated migraine at the first sign of pain, while pain was mild, but not more than 2 hours after onset with oral sumatriptan, 50 or 100 mg, or matching placebo. The primary end point was pain-free relief at 2 hours after treatment with 50 mg of sumatriptan compared with placebo.

RESULTS: There were 354 patients in study 1 and 337 patients in study 2. Significantly more patients treated with sumatriptan, 50 and 100 mg, were completely free from pain 2 and 4 hours after the treatment versus patients treated with placebo (at 2 hours, 50% and 57% vs. 29%; at 4 hours, 61% and 68% vs. 30%; for both, p < 0.001). Also, significantly more patients treated with sumatriptan, 50 and 100 mg, were migraine-free (no pain or associated symptoms) versus those treated with placebo at 2 and 4 hours after the treatment (at 2 hours, 43% and 49% vs. 24%; at 4 hours, 54% and 63% vs. 28%; for both, p < 0.001). The incidence of overall adverse events was low with the 50- and 100-mg dose of sumatriptan (placebo, 7%; sumatriptan at 50 mg, 14%; sumatriptan at 100 mg, 16%).

CONCLUSIONS: Treatment of migraine at the first sign of pain with sumatriptan, 50-mg and 100-mg tablets, provides superior pain-free relief at 2 and 4 hours after the treatment compared with the placebo. Results of these studies suggest that sumatriptan at 100 mg may be more efficacious than at 50 mg when used in the early treatment paradigm. Because these studies were not powered to detect statistical differences between active doses, studies to investigate this finding are warranted.