Smith TR et al. (2005) Sumatriptan and naproxen sodium for the acute treatment of migraine. Headache 45: 983–991

A prospective multicenter study—one of the first of its kind—has shown encouraging results for a combined acute treatment for migraine, involving a triptan and an analgesic.

Smith et al. treated a cohort of 972 patients, containing both males and females, in their four-arm, double-blind study. The patients were randomly assigned to treatment with placebo, naproxen sodium 500 mg, sumatriptan 50 mg, or a combination of the two drugs at the aforementioned doses. At the onset of a moderate or severe migraine attack, patients completed study diary cards before taking their assigned medication. They then completed diary cards at 15 min intervals for up to 2 hours, and at 30 min intervals 2–4 hours after medication.

The primary endpoint of the study was a 'sustained pain response'. This was achieved in 46% of patients assigned to the combination therapy—significantly greater than that achieved in the patients taking sumatriptan (29%), naproxen sodium (25%), or placebo (17%) (P <0.001). Headache response after 2 hours was also significantly higher in patients treated with combined medication than in those treated with sumatriptan, naproxen sodium, or placebo (65% vs 49%, 46% and 27%, respectively; P <0.001).

The authors suggest that multimechanism acute treatment for migraine using a triptan and an analgesic offers improved clinical benefits over monotherapy with these medications, and is well tolerated and not associated with a significant increase in adverse events compared with monotherapy.