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

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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.

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Abbreviations

IHS:

International headache society

NS:

Nasal Spray

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Acknowledgements

We would like to thank our colleagues in the Medical Research Group of Egypt (MRGE, www.mrg-egypt.org) for the support and encouragement.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Amr Menshawy, Ammar Ismail, Esraa Ghanem & Ravikishore Pallanti

  2. Medical Research Group of Egypt, Cairo, Egypt

    Amr Menshawy, Hussien Ahmed, Ammar Ismail, Abdelrahman Ibrahim Abushouk, Esraa Ghanem & Ahmed Negida

  3. Al-Azhar Medical Students’ Association (AMSA), Cairo, Egypt

    Amr Menshawy

  4. Faculty of Medicine, Zagazig University, El Sharkia, Egypt

    Hussien Ahmed & Ahmed Negida

  5. Student Research Unit, Zagazig University, El Sharkia, Egypt

    Hussien Ahmed & Ahmed Negida

  6. NovaMed Medical Research Association, Cairo, Egypt

    Ammar Ismail & Abdelrahman Ibrahim Abushouk

  7. Faculty of Medicine, Ain Shams University, Ramsis St, Cairo, 11591, Egypt

    Abdelrahman Ibrahim Abushouk

  8. Osmania College of Medicine, Hyderabad, India

    Ravikishore Pallanti

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  1. Amr Menshawy
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  2. Hussien Ahmed
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Correspondence to Abdelrahman Ibrahim Abushouk.

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Conflict of interest

Ahmed Negida acts as a biostatistician for clinical studies carried out by Clinart MENA CRO on behalf of multiple pharmaceutical companies as Pfizer and Abbvie. The remaining co-authors have nothing to declare.

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Menshawy, A., Ahmed, H., Ismail, A. et al. Intranasal sumatriptan for acute migraine attacks: a systematic review and meta-analysis. Neurol Sci 39, 31–44 (2018). https://doi.org/10.1007/s10072-017-3119-y

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  • DOI: https://doi.org/10.1007/s10072-017-3119-y

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