Thirteen RCTs (9,509 patients) were included in the review: 12 were double-blinded; one was an open-label RCT.
Comparative triptan trials: Two trials, one comparing almotriptan with sumatriptan and one comparing almotriptan with zolmitriptan, found the drugs to be of similar efficacy. Almotriptan 12.5 mg (but not 25 mg) was associated with fewer adverse events than sumatriptan, (9 per cent versus 22 per cent, p<0.001) and zolmatripan (11 per cent versus 16 per cent, p<0.05).
IndoProCaf versus sumatriptan: IndoProCaf was associated with a higher pain free at two-hour rate than sumatriptan (49 per cent versus 34 per cent, p<0.01) in one trial, but there was no significant difference in the same outcome in another trial.
Triptans versus aspirin and non-steroidal anti-inflammatory drugs (NSAIDs): Three trials showed that NSAIDs or aspirin were as effective as triptans; two showed that NSAIDs/aspirin were as effective as each other. Two studies showed that sumatriptan/naproxen sodium combination was more effective than either treatment alone.
Triptan versus caffeine/ergotamine: Eletriptan (40 mg and 80 mg) and almotriptan were significantly more effective at improving pain than caffeine/ergotamine in one trial each (54 per cent and 68 per cent versus 33 per cent, p<0.001 and 21 per cent versus 14 per cent, p<0.05).