Placebo-Controlled Comparison of Effervescent Acetylsalicylic Acid, Sumatriptan and Ibuprofen in the Treatment of Migraine Attacks

Acetylsalicylic acid (ASA) in combination with metoclopramide has been frequently used in clinical trials in the acute treatment of migraine attacks. Recently the efficacy of a new high buffered formulation of 1000 mg effervescent ASA without metoclopramide compared to placebo has been shown. To further confirm the efficacy of this new formulation in comparison with a triptan and a nonsteroidal anti-inflammatory drug (ibuprofen) a three-fold crossover, double-blind, randomized trial with 312 patients was conducted in Germany, Italy and Spain. Effervescent ASA (1000 mg) was compared to encapsulated sumatriptan (50 mg), ibuprofen (400 mg) and placebo. The percentage of patients with reduction in headache severity from moderate or severe to mild or no pain (primary endpoint) was 52.5% for ASA, 60.2% for ibuprofen, 55.8% for sumatriptan and 30.6% for placebo. All active treatments were superior to placebo ( P < 0.0001), whereas active treatments were not statistically different. The number of patients who were pain-free at 2 h was 27.1%, 33.2%, 37.1% and 12.6% for those treated with ASA, ibuprofen, sumatriptan or placebo, respectively. The difference between ASA and sumatriptan was statistically significant ( P = 0.025). With respect to other secondary efficacy criteria and accompanying symptoms no statistically significant differences between ASA and ibuprofen or sumatriptan were found. Drug-related adverse events were reported in 4.1%, 5.7%, 6.6% and 4.5% of patients treated with ASA, ibuprofen sumatriptan or placebo. This study showed that 1000 mg effervescent ASA is as effective as 50 mg sumatriptan and 400 mg ibuprofen in the treatment of migraine attacks regarding headache relief from moderate/severe to mild/no pain at 2 h. Regarding pain-free at 2 h sumatriptan was most effective.

[Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study]

BACKGROUND

Flupirtine with its specific mode of action as Selective Neuronal Potassium Channel Opener (SNEPCO) shows analgesic, muscle tone normalizing properties and iprotects from chronification. By means of an open multicentre drug monitoring study new data should be accumulated in terms of efficacy and patient's tolerance of flupirtine upon treatment of acute and chronic pain associated with muscle tenseness.

RESULTS

Regarding acute and chronic pain, significant reduction of pain intensity, pain upon pressure and muscular tenseness could be proved. Simultaneously, decrease of sleep disorders due to pain and strong reduction of restrictions in daily life caused by pain improved distinctly patient's quality of life. Efficacy and tolerance has mainly been rated as good and very good respectively by physicians and patients, the number of undesired drug reactions being under 1%.

CONCLUSION

Data of this study confirm the analgesic and muscle tone normalizing efficacy of flupirtine upon treatment of acute and chronic pain associated with muscle tenseness and show, that flupirtine has to be considered as a substance of first choice for the treatment of these disorders.