I chose to review this article as I was interested in the safety and efficacy of the newer medications for migraine treatment that I have seen being prescribed in the family medicine practice I am rotating in. The study evaluated five oral CGRP antagonists against placebo and triptans in the treatment of acute migraine. This study was published in 2021, with a total of 17 trials meeting eligibility criteria and comprising a sample size of 13,995 patients. CGRP antagonists were found to show significant efficacy compared placebo in regards to pain relief and nausea at 2 and 24 hours post-dose. However, triptans showed superior efficacy as compared to CGRP antagonists with respect to the same outcomes. One CGRP antagonist, Ubrogepant, showed a much more favorable safety profile than triptans. The study concluded that use of CGRP antagonists as first-line standard treatment is not well-established based on efficacy, as triptans provide better pain relief in the acute treatment of migraine. However, CGRP antagonists are a safer option for patients with cardiovascular co-morbidities as their mechanism of action does not involve vasoconstriction unlike the triptans and may be the best choice for the first-line medication for acute migraine in patients with cardiovascular disease, in whom triptan use is restricted.
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