A comparison of subcutaneous sumatriptan and dihydroergotamine nasal spray in the acute treatment of migraine

Abstract

We compared the efficacy and safety of subcutaneous (SC) sumatriptan (6 mg) with that of dihydroergotamine (DHE) nasal spray (1 mg plus optional 1 mg) in the acute treatment of migraine. Two hundred sixty-six adult migraineurs (International Headache Society criteria) completed a multicenter, double-blind, double-dummy, cross-over study. Patients took SC sumatriptan for one attack and DHE nasal spray for the other in random order. Data from both treatment periods show that at all time points from 15 minutes, SC sumatriptan was significantly better than DHE nasal spray at providing both headache relief (moderate/severe headache improving to mild/none) and resolution of headache. Similarly, SC sumatriptan was superior to DHE nasal spray for the other efficacy end points assessed in the study. Patients reported that both treatments were well tolerated. Adverse events were reported by 43% of patients taking SC sumatriptan and 22% of patients taking DHE nasal spray. These were usually mild and transient. We conclude that subcutaneous sumatriptan has a faster onset of action than DHE nasal spray and provides greater relief of acute migraine symptoms.

Ergotamine, Dihydroergotamine: Current Uses and Problems

“…Intranasal dihydroergotamine 2 mg was superior to placebo with an effect after only 30 min 14 . In two comparative RCTs intranasal dihydroergotamine 1 mg (plus an optional dose of 1 mg after 30 min) was inferior to 6 mg subcutaneous sumatriptan and 20 mg intranasal sumatriptan 15,16 . Subcutaneous dihydroergotamine 1 mg was inferior to 6 mg subcutaneous sumatriptan for the first 2 h, but apparently comparable thereafter 17 .…”

Migraine: pharmacotherapy in the emergency department

“…27 Sumatriptan has reported to be more eVective than DHE nasal spray. 31 It has also been reported to be of similar eVectiveness to chlorpromazine (one study) 15 and less eVective than prochlorperazine (one study). 22 Sumatriptan treated patients reported a significantly higher rate of headache recurrence within 24 hours.…”

Die Attackenbehandlung der Migräne

“…Mit Ausnahme der höheren Wiederkehrkopfschmerzrate sind die Triptane den Ergotalkaloiden in allen Bereichen überlegen [5,40,42,47].…”

“…eindeutig überlegen. [3,5,7,8,10,12,14,15,16,17,30,31,34,35,39,40,42,44,45,47]. Aufgrund der guten Verträglichkeit kann Naratriptan insbesondere auch Patienten empfohlen werden, die erstmalig mit einem Triptan behandelt werden.…”