Objective:

This network meta-analysis evaluates the effectiveness of intravenous migraine abortive medications in clinical practice, focusing on pain relief as demonstrated in randomized controlled trials.

Background:

Migraines are a recurrent, disabling headache disorder with high worldwide prevalence. Physicians use various intravenous medications to alleviate migraine pain and symptoms. However, there is a lack of consensus on the most effective intravenous abortive migraine treatments.

Design/Methods:

We searched PubMed, EMBASE, Scopus, and Cochrane (CENTRAL) for randomized controlled trials (RCTs) of intravenous migraine abortive medications in English. Non-intravenous treatments, non-migraine headaches, and studies without primary outcome measures (e.g., pain scores) were excluded. We used Rayyan for study selection and duplicate detection. We collected data on study design, sample size, treatment arms, dosages, pain outcomes, and adverse events for the included studies. We examined pain scores at baseline and 60 minutes post-treatment, using a p-score (ranges from 0–1, with closer to 1 indicating higher effectiveness) to measure the certainty that a specific treatment is superior to all other treatments in the study.

Results:

Of 5471 articles identified after deduplication, 16 studies met inclusion and exclusion criteria. Among intravenous migraine abortives studied, acetaminophen was most effective in pain reduction at 60 minutes from baseline (p-score 0.8522). Magnesium sulfate, haloperidol, and prochlorperazine followed (p-scores 0.7952, 0.7604, and 0.7057, respectively). Sumatriptan was the least effective with a p-score of 0.0805.

Conclusions:

This network meta-analysis provides valuable information on the effectiveness of various intravenous migraine abortive drugs. Acetaminophen was the most effective for pain relief at 60 minutes. Further research is needed to corroborate these findings and examine the adverse effects of these medications.