Acute pharmacological treatments for migraine: A systematic review with Mexican healthcare perspective

Introduction Migraine is a common and disabling neurological disorder that requires effective acute treatment. However, access to optimal therapies varies significantly across healthcare systems worldwide. This systematic review assesses acute pharmacological treatments for migraine from a Mexican healthcare perspective, focusing on drug availability and proposing a practical treatment algorithm. Methods Following PRISMA guidelines, we systematically searched multiple databases from inception to November 2024. We included randomized controlled trials evaluating acute treatments for migraine in adults. Treatment efficacy data were synthesized narratively in accordance with the International Headache Society guidelines. Drug availability in Mexico was assessed through regulatory databases and clinical practice surveys. Results Thirty-six randomized controlled trials met inclusion criteria, evaluating triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), calcitonin gene-related peptide antagonists, ditans, and combination therapies. Subcutaneous sumatriptan demonstrated high efficacy (83% pain relief at 2 hours), but it is limited in availability within the Mexican public healthcare system. Oral triptans (sumatriptan, zolmitriptan, eletriptan, and rizatriptan) are available; however, access varies between the public and private sectors. NSAIDs like ketorolac and ketoprofen show good efficacy and are widely accessible. Newer agents (rimegepant, lasmiditan) are available but expensive, limiting healthcare access. Conclusion Effective migraine treatment in Mexico necessitates a balance between evidence-based medicine and healthcare realities. While triptans remain first-line per international guidelines, NSAIDs offer practical alternatives given their accessibility. A structured approach considering drug availability, cost, and patient characteristics can optimize migraine care in Mexico and similar healthcare systems.