Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital

Why is the therapeutic effect of acute antimigraine drugs delayed? A review of controlled trials and hypotheses about the delay of effect

Research output: Contribution to journalReviewResearchpeer-review


  1. Obesity-induced CYP2E1 activity in children

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Higher chlorzoxazone clearance in obese children compared with nonobese peers

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Development of one paediatric and one neonatal formulary list in hospital settings

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

In randomised controlled trials (RCTs) of oral drug treatment of migraine attacks, efficacy is evaluated after 2 hours. The effect of oral naratriptan 2.5 mg with a maximum blood concentration (Tmax ) at 2 hours increases from 2 to 4 hours in RCTs. To check whether such a delayed effect is also present for other oral antimigraine drugs, we hand-searched the literature for publications on RCTs reporting efficacy. Two triptans, 3 nonsteroidal anti-inflammatory drugs (NSAIDs), a triptan combined with an NSAID and a calcitonin gene-related peptide receptor antagonist were evaluated for their therapeutic gain with determination of time to maximum effect (Emax ). Emax was compared with known Tmax from pharmacokinetic studies to estimate the delay to pain-free. The delay in therapeutic gain varied from 1-2 hours for zolmitriptan 5 mg to 7 hours for naproxen 500 mg. An increase in effect from 2 to 4 hours was observed after eletriptan 40 mg, frovatriptan 2.5 mg and lasmiditan 200 mg, and after rizatriptan 10 mg (Tmax = 1 h) from 1 to 2 hours. This strongly indicates a general delay of effect in oral antimigraine drugs. A review of 5 possible effects of triptans on the trigemino-vascular system did not yield a simple explanation for the delay. In addition, Emax for triptans probably depends partly on the rise in plasma levels and not only on its maximum. The most likely explanation for the delay in effect is that a complex antimigraine system with more than 1 site of action is involved.

Original languageEnglish
JournalBritish Journal of Clinical Pharmacology
Issue number11
Pages (from-to)2487-2498
Number of pages12
Publication statusPublished - 2019

    Research areas

  • acute antimigraine drug, effect delay, NSAID, time-effect curvetriptan

ID: 57959833