Simultaneous Comparisons of 25 Acute Migraine Medications Based on 10 Million Users' Self-Reported Records From a...

Area of Science:

• Neurology
• Pharmacology
• Data Science

Background:

• Existing acute migraine treatments lack large-scale, head-to-head comparisons based on real-world patient experiences.
• Real-world data is crucial for understanding the comparative effectiveness of various acute migraine medications.

Purpose of the Study:

• To conduct a large-scale, head-to-head comparison of the effectiveness of 25 acute migraine medications.
• To analyze real-world patient-reported outcomes from a smartphone e-diary application.

Main Methods:

• Retrospective analysis of 10,842,795 migraine attack records from a smartphone e-diary (June 2014 - July 2020).
• Analysis included 7 classes of acute medications (acetaminophen, NSAIDs, triptans, combination analgesics, ergots, antiemetics, opioids).
• A nested logistic regression model was used to determine the odds ratio (OR) of treatment effectiveness, adjusting for covariates.

Main Results:

• Triptans (mean OR 4.8), ergots (mean OR 3.02), and antiemetics (mean OR 2.67) were the most effective medication classes.
• Eletriptan (OR 6.1), zolmitriptan (OR 5.7), and sumatriptan (OR 5.2) showed the highest individual effectiveness.
• Acetaminophen and some NSAIDs showed effectiveness around or below the reference medication, ibuprofen.

Conclusions:

• Big data analysis of real-world migraine attack records confirms the high effectiveness of triptans, ergots, and antiemetics.
• Findings align with clinical guidelines and provide generalizable insights for acute migraine treatment.
• The study offers Class IV evidence supporting the effectiveness of these medication classes over ibuprofen.