New, more expensive migraine drugs are no more effective against the throbbing headaches than traditional painkillers, and even performed worse than an older range of treatments called triptans, said a massive global analysis Thursday.
Migraines are severe, often disabling headaches which affect at least one in seven adults globally, according to the World Health Organization. They are also up to three times more common in women than men.
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For decades, cheap and widely available painkillers such as aspirin and ibuprofen have been prescribed for migraines, as well as the more powerful triptans, which change how blood circulates in the brain.
But in recent years, a new generation of migraine drugs called gepants has emerged.
This includes rimegepant, which is sold by US pharma giant Pfizer under the brand name Vydura, and ubrogepant, sold as Ubrelvy by firm Abbvie.
Migraine drugs can represent big money for pharmaceutical firms, as shown when Pfizer acquired Biohaven — which developed rimegepant — for more than $10 billion in 2022.
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These new drugs have generally been tested against a placebo.
However a new meta-analysis, published in the BMJ journal, brought together 137 previous randomized, controlled trials looking at how 17 different treatments affected a total of nearly 90,000 people.
The newer and more expensive drugs rimegepant and ubrogepant — as well as another called lasmiditan, which can have drowsy side effects — were about as effective as paracetamol and anti-inflammatory painkillers, the study said.
Meanwhile triptans — such as eletriptan, rizatriptan, sumatriptan and zolmitriptan -- performed best, the study said, regretting that they "are currently widely underused".
The researchers recommended doctors first prescribe triptans — and for certain patients who cannot take triptans due to heart problems, they recommended traditional pain killers such as aspirin and ibuprofen.
The newer gepants drugs should be considered a third option, the study concluded.
Study co-author Andrea Cipriani of Oxford University emphasised how important it was to properly treat the "huge problem" of migraines.
"It's the leading cause of disability in young women and also is associated with high personal health care and societal costs," he told a press conference.