COMPARATIVE EVALUATION OF THE EFFICACY AND SAFETY OF DIFFERENT TRIPTAN DELIVERY ROUTES (INTRANASAL VS. ORAL) IN ACUTE MIGRAINE ATTACK MITIGATION AMONG CHILDREN AND ADOLESCENTS: A SYSTEMATIC LITERATURE REVIEW

Abstract

Background: Migraine is one of the most prevalent neurovascular pathologies within the pediatric and adolescent population, necessitating timely and effective abortive therapeutic interventions. This study presents a systematic and comparative evaluation of the clinical efficacy and safety profiles of intranasal versus oral triptan formulations (selective 5-HT1B/1D serotonin receptor agonists) under conditions compromised by migraine-induced gastrostasis and emetic syndrome in children and adolescents.

Methods: Utilizing data from electronic databases including PubMed, the Cochrane Library, and ScienceDirect, a systematic analysis of randomized controlled trials (RCTs) involving patients aged 6 to 18 years was conducted in strict accordance with the PRISMA guidelines. The primary clinical endpoints evaluated were pain relief or complete resolution at 30 minutes and 2 hours post-administration, alongside the dynamics of concurrent autonomic symptoms.

Results: Pooled data demonstrated that intranasal triptans exhibit a significantly superior efficacy in pain reduction within the initial 30 minutes of an attack (42%–46%) compared to oral alternatives (18%–22%, p < 0.01), primarily due to their ability to bypass pre-systemic hepatic metabolism. Although the rates of complete headache resolution at 2 hours post-dose were statistically comparable between the two cohorts (64%–68% vs. 60%–65%, p > 0.05), the intranasal spray demonstrated absolute clinical superiority in cases complicated by vomiting and gastrostasis.

Conclusion: Both triptan delivery routes demonstrate high safety profiles in pediatric practice. Nonetheless, in clinical scenarios marked by the hyperacute phase of a migraine attack or accompanied by severe gastrointestinal dysfunction, prioritizing intranasal sprays based on an individualized therapeutic approach is highly warranted.