AAN 2023 | Simultaneous comparison of 25 acute migraine medications: a big data analysis

In a groundbreaking study presented at the American Academy of Neurology Annual Meeting 2023, Chia-Chun Chiang, MD, Mayo Clinic, Rochester, MN, utilized a big data approach to simultaneously compare the efficacy of 25 acute migraine medications. The goal was to address the limited literature available on comparing multiple medications for migraine treatment, which mainly relied on small-scale randomized trials involving only a few medications. The study leveraged the power of real-world patient-reported health data extracted from a migraine smartphone application called Migraine Buddy. With a dataset of 10 million reported migraine attacks, a two-level nested logistic regression model was employed to analyze the complex correlations between medication usage and user reports of multiple migraine attacks. The findings revealed that, overall, triptans were considered the most helpful class of medication, followed by ergots, antiemetics, and opioids. Among the triptans, eletriptan emerged as the most effective medication, while frovatriptan was reported as the least helpful, it was still more effective than other classes of medication. The study highlights the importance of triptans as the first-line choice for migraine-specific medication, with user perceptions indicating their greater efficacy compared to opioids. It should be noted that the analysis did not include newer migraine-specific medications such as gepants and ditans, which will be incorporated in future analyses. This pioneering research marks the first-ever big data analysis for a head-to-head comparison of 25 migraine medications. The insights gained from this analysis, derived from patient-entered data, provide valuable guidance for clinicians and support the use of triptans when available. Dr Chiang summarises how the study demonstrates the potential of utilizing patient-reported data to uncover significant findings in the realm of migraine treatment.

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