Sumatriptan (50 mg tablets vs. 25 mg suppositories) in the acute treatment of menstrually related migraine and oral contraceptive-induced menstrual migraine: a pilot study

Migraine attacks are common in the perimenstrual period (menstrually-related migraine, MRM) and can be particularly exacerbated by the cyclic suspension of oral contraceptives (oral contraceptive-induced menstrual migraine, OCMM). This cross-over, randomised study evaluated the efficacy and tolerability of rectal (25 mg) and oral (50 mg) sumatriptan in the treatment of 232 menstrual migraine attacks (135 MRM and 97 OCMM). Two hours after suppository administration, 72% of patients in the MRM group achieved pain relief and 24% were pain free; after tablet administration, the percentages were 66% and 27%, respectively. In the OCMM group 55% of patients improved at 2 h with suppositories and 46% with tablets, 27% of patients were pain-free after suppositories and 18% after tablets. Fifty percent of patients given suppositories were pain-free at 4 h post-treatment and 47% of those given tablets. Sumatriptan also effectively alleviated symptoms associated with migraine, such as nausea, vomiting and photo/phonophobia. A single dose of medication sufficed for pain relief without relapse in 47.4% of the attacks (MRM: 66%; OCMM: 33%). Both formulations were well tolerated.