In an open, randomized cross-over study in 124 patients, we compared the efficacy, safety and patient preference of oral and subcutaneous sumatriptan in the acute treatment of migraine. Patients were treated for 3 attacks or 3 months and then crossed over. Primary clinical efficacy was defined as a reduction in headache severity on a four-point self-rating scale from severe (3) or moderate (2) to mild (1) or none (0), or mild (1) to none (0). Efficacy was evaluated 2 h after the administration of subcutaneous and 4 h after the administration of oral sumatriptan. Subcutaneous sumatriptan was significantly more effective than oral sumatriptan in relieving headache (over all three attacks 78% vs 61% improvement), improving clinical disability (55% vs 41% improvement) and relieving nausea (69% vs 53%), vomiting (72% vs 32%) and phono or photophobia (67% vs 49%). Median time to recurrence was shorter after subcutaneous (12.5 h) than after oral sumatriptan (18 h); the number of patients experiencing a recurrence was similar. Patients reported more adverse events after subcutaneous sumatriptan (1.32 per attack) than after the oral form (0.85 per attack), but all adverse events were mild to moderate in intensity and of short duration. Patient opinion was more often positive after subcutaneous sumatriptan. These results may be useful in counselling patients to choose between the available marketed formulations of sumatriptan.

Acute migraine, Comparative trial, Cross-over study, Sumatriptan
dx.doi.org/10.1046/j.1468-2982.1997.1705591.x, hdl.handle.net/1765/62788
Cephalalgia: an international journal of headache
Erasmus MC: University Medical Center Rotterdam

Carpay, J.A, Matthijsse, P, Steinbuch, M, & Mulder, P.G.H. (1997). Oral and subcutaneous sumatriptan in the acute treatment of migraine: An open randomized cross-over study. Cephalalgia: an international journal of headache, 17(5), 591–595. doi:10.1046/j.1468-2982.1997.1705591.x