SUBCUTANEOUS SUMATRIPTAN FOR TREATMENT OF ACUTE MIGRAINE IN PATIENTS ADMITTED TO THE EMERGENCY DEPARTMENT - A MULTICENTER STUDY

Study objective: To assess the efficacy of SC sumatriptan injection ve rsus placebo in the treatment of acute migraine in ED patients and tha t of open-label 100 mg sumatriptan PO tablets for recurrent migraine. Design: Randomized, double-blind, placebo-controlled, multi-centertria l. Setting: Twelve EDs in the United States. Participants: Adult patie nts presenting to the ED from September 1992 through April 1993 with a diagnosis of migraine as determined by International Headache Society criteria. Patients were randomized to receive 6 mg sumatriptan SC or placebo. Patients were monitored for improvement in headache severity using a four-point scale and for time to meaningful relief using a sto pwatch. The time to discharge from the ED was recorded. An open-label 100 mg sumatriptan PO tablet was given to all patients on discharge fr om the ED for use at home if the headache recurred within 24 hours. Re sults: One hundred thirty-six patients were enrolled. Seventy five per cent of patients treated with sumatriptan achieved meaningful relief c ompared with 35% treated with placebo (P<.001). The median time to mea ningful relief was 34 minutes in the group that received sumatriptan. Seventy percent of patients in the sumatriptan group versus 35% in the placebo group reported mild or no pain at discharge (P<.001). Migrain e-associated symptoms such as nausea, photophobia, and phonophobia wer e significantly reduced in the sumatriptan group (P<.005). The median time to discharge from the ED was shorter for the sumatriptan group th an for the placebo group (60 versus 96 minutes, respectively; P=.001). At baseline, 15% of patients in the sumatriptan group and 19% of pati ents in the placebo group reported mild or no clinical disability. At the time of discharge, patients with mild or no disability increased t o 75% in the sumatriptan group compared with 44% in the placebo group (P=.001). Fifty-seven of 92 patients (62%) with mild or no pain at dis charge took open-label oral sumatriptan for headache recurrence, and 3 7 (65%) experi enced meaningful relief within 2 hours. Median time to meaningful relief after oral sumatriptan was 65 minutes.Conclusion: Su matriptan (6 mg SC) is effective in treating acute migraine in the ED. Oral sumatriptan (100 mg) is effective in treating headache recurrenc e within 24 hours.