Intranasal Sumatriptan More Effectively Reduces Migraine-Associated Nausea

woman laying on a couch with her hand on her head
woman laying on a couch with her hand on her head
The efficacy of oral versus intranasal delivery of sumatriptan on migraine-related nausea was evaluated in the COMPASS study.

Nasal sumatriptan powder was associated with more favorable nausea outcomes compared with oral sumatriptan tablets in patients with acute migraine, according to study findings presented in Headache.

The study investigators evaluated patients enrolled in the COMPASS study ( Identifier: NCT01667679), which assessed the efficacy of 2 migraine treatments: 22 mg sumatriptan nasal powder (AVP-825) and oral 100 mg sumatriptan tablets. The researchers hypothesized that AVP-825 would be more effective than oral sumatriptan in reducing nausea.

Overall, AVP-825 administration resulted in significantly faster rates of decline in nausea symptoms during migraine attacks compared with oral sumatriptan tablets (P <.0001). 

In addition, the odds of developing nausea were significantly lower in the AVP-825 group vs oral sumatriptan arm (P <.05 for all time points).

Treatment-emergent nausea significantly increased at a faster rate at 10, 15, 30, and 45 minutes following therapy in patients treated with oral sumatriptan compared with AVP-825 (P <.05 for all). From 45 minutes to 90 minutes, treatment-emergent adverse events were lower among patients randomized to AVP-825 vs oral sumatriptan (P <.05). In regard to long-term changes in nausea over time, the investigators found no difference between the two groups (P =.49).

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Since the COMPASS trial did not include a placebo group, the ability to directly compare comparative effects of different therapies was not possible. 

Despite the lack of a comparison arm, the investigators believe these findings may ultimately guide clinician decision-making to optimize migraine treatment.


Lipton RB, McGinley JS, Shulman KJ, et al. AVP-825 (sumatriptan nasal powder) reduces nausea compared to sumatriptan tablets: Results of the COMPASS randomized clinical trial [published online October 16, 2017]. Headache. doi:10.1111/head.13199