Efficacy of Parecoxib, Sumatriptan, and Rizatriptan in the Treatment of Acute Migraine Attacks

Abstract

Triptans and analgetic nonsteroidal inflammatory drugs reduce acute pain syndromes in migraine. A further treatment option for an acute headache attack in patients with migraine may be the application of cyclooxygenase-2-specific inhibitors, as they have anti-inflammatory and analgesic properties. The objective of this pilot study was to investigate the effects of an oral fast-dissolving tablet of 10 mg of rizatriptan, an intravenous infusion of 40 mg of parecoxib, and a subcutaneous pen injection of sumatriptan (6 mg/0.5 mL) on pain relief in 3 cohorts of patients with episodic migraine. They were treated owing to the acute onset of a pain attack as a case of emergency. They were randomized to treatment with sumatriptan, rizatriptan, or parecoxib. The participants completed a visual analog scale for pain intensity at baseline before the drug administration and then after intervals of 20, 30, 60, and 120 minutes. Rizatriptan, parecoxib, and sumatriptan reduced pain symptoms. Twenty and 30 minutes after drug intake, rizatriptan was more efficacious than parecoxib and sumatriptan, and parecoxib was more effective than sumatriptan. Only a significant difference between rizatriptan and sumatriptan was found after 60 and 120 minutes. This trial demonstrates the effectiveness of a parecoxib infusion in the treatment of acute migraine and that the circumvention of the first pass effect of the liver by rizatriptan may be beneficial for fast pain relief.

Comparison between metamizole and triptans for migraine treatment: a systematic review and network meta-analysis

“…All studies involved triptans and no study was performed with dipyrone. 24,35,36,55,68,69,73,85,129,130,135,140,143,145,152,161,166,177,211 Barbanti et al evaluated equivalent work time loss after a migraine attack, and the results showed 1.9 ± 2.3 and 2.5 ± 4.7 hours lost from work for sumatriptan 100 mg and 50 mg, respectively, compared with 3.5 ± 4.3 for placebo. Sumatriptan 100 mg was also able to better restore functional ability.…”

“…Comparison between metamizole and triptans for migraine treatment: a systematic review and network meta-analysis Pascual et al 166 Adults -33.7 years (16-66) n=481 (399 female and 82 male)…”

The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis

“…reported their source of funding or declared potential conflicts of interest 11,40,42,44,46,47,50,54,[56][57][58]64,66,68,71,72,[75][76][77][78][79][80][81]83,84,86,[89][90][91]95,98,99,106,[108][109][110][111]115,118,125,130 while potential conflict of interest was identified in 16 studies 42,44,47,50,66,68,71,72,75,76,106,…”

“…Triptan agents were the most commonly studied parenteral agents (n = 27 studies). 41,42,44,55,58,64,66,68,75,76,78,[82][83][84]86,111,113,118,[120][121][122][124][125][126][127][128][129] Sumatriptan was the most frequently studied agent 41,42,44,55,58,64,66,68,75,76,78,[82][83][84]86,111,113,[120][121][122][124][125][126][127][128]…”

“…110 Non-steroidal anti-inflammatory drugs A total of 24 studies provided patients with NSA IDs. 36,50,51,57,63,65,70,71,79,[89][90][91]93,[97][98][99][100][101][109][110][111][112]125,131 Ketorolac was the most-studied NSAID agent, which was administered as a single 30 mg IV dose 57,70,79 or a single intramuscular injection of 30 65 or 60 mg. 50,51,63,71 Other studies provided patients with dexketoprofen, 90,91,93,98,99 lysine-acetylsalicylic acid, 109,110,112,125 diclofenac, 36,97,131 ibuprofen, 53,89,91 dipyrone, 100 parecoxib, 111 or lysine clonixidate.…”