Condition

Migraine

Severe recurring headaches with neurological symptoms

1.2B
People Affected
100
Active Trials
90.2M
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Erenumab
85% Effectiveness• 92% Confidence• 65% Safety• 64 trials• 20K participants
HIGH EvidencePoor ValueDose: 70mg or 140mg subcutaneous monthly
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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65
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

Lifetime

Response Rate

45%

Remission Rate

15%

Number Needed to Treat (NNT)

4

Common Side Effects:

Constipation: 15%
Muscle cramps/spasms: 8%
Injection site reaction: 6%
Hypertension (rare): 1%

Annual Cost of Care

Drug Cost

$9,000

Monitoring

$200

Side Effects

$150

Total Annual

$9,350

Cost-Effectiveness

POOR

QALYs Gained

0.1

ICER

$250,000/QALY

Cost per Remission

$62,333

Cost per Responder

$20,778

Treatment Outcomes
Primary Outcomes
Mean Monthly Migraine Days8.4 days/month
-23.8% (-2.0 days/month)
Mean Monthly Headache Days12.0 days/month
-20.8% (-2.5 days/month)
Acute Migraine-Specific Medication Days4.8 days/month
-31.3% (-1.5 days/month)
Secondary Benefits
Migraine Disability Assessment (MIDAS) ScoreMIDAS Score: 38 (severe disability)
-36.8% (-14 points)
Headache Impact Test (HIT-6) ScoreHIT-6 Score: 60 (severe impact)
-9.2% (-5.5 points)
Physical Functioning (SF-36 Subscale)SF-36 Physical Function: 70/100
+3.6% (+2.5 points)
Common Side Effects
Constipation
+15%
Muscle cramps/spasms
+8%
Injection site reaction
+6%

Clinical Trial Phases:

Phase 3Phase 4
2
Rimegepant
80% Effectiveness• 90% Confidence• 70% Safety• 45 trials• 15K participants
HIGH EvidencePoor ValueDose: 75mg oral (acute or every other day for prophylaxis)
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Comparative Safety Scale(Higher is safer)

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Meth💀
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70
DangerousModerateSafe

Time to Effect

1-2 hours (acute), 1-2 weeks (prophylaxis)

Duration

As needed (acute), long-term (prophylaxis)

Response Rate

60%

Remission Rate

%

Number Needed to Treat (NNT)

7

Common Side Effects:

Nausea: 3%
Abdominal pain: 2%
Somnolence: 1%

Annual Cost of Care

Drug Cost

$12,000

Monitoring

$100

Side Effects

$50

Total Annual

$12,150

Cost-Effectiveness

POOR

QALYs Gained

0.08

ICER

$300,000/QALY

Cost per Responder

$20,250

Treatment Outcomes
Primary Outcomes
Pain freedom at 2 hours post-dose11% of patients (placebo effect)
+90.9% (+10 percentage points)
Freedom from most bothersome symptom (MBS) at 2 hours25% of patients (placebo effect)
+44% (+11 percentage points)
Monthly Migraine Days (MMD)8.5 migraine days/month
-50.6% (-4.3 migraine days/month)
Sustained pain freedom (2-24 hours)6% of patients (placebo effect)
+133.3% (+8 percentage points)
Secondary Benefits
Headache Impact Test (HIT-6) Score60 points on HIT-6 scale (0-78)
-9.2% (-5.5 points)
Migraine-Specific Quality of Life Questionnaire (MSQOL-PF) Score60 points on MSQOL-PF scale (0-100)
+11.7% (+7 points)
Acute Migraine-Specific Medication Days4.5 acute medication days/month
-55.6% (-2.5 days/month)
Common Side Effects
Nausea
+3%
Abdominal pain
+2%
Somnolence
+1%

Clinical Trial Phases:

Phase 3Phase 4
3
Sumatriptan
78% Effectiveness• 95% Confidence• 60% Safety• 103 trials• 200K participants
HIGH EvidenceExcellent ValueDose: 25-100mg oral, 6mg subcutaneous
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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Tylenol💊
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60
DangerousModerateSafe

Time to Effect

30 minutes - 2 hours

Duration

As needed

Response Rate

70%

Remission Rate

%

Number Needed to Treat (NNT)

3

Common Side Effects:

Chest tightness/pressure: 5%
Tingling/numbness: 4%
Dizziness: 3%
Flushing: 2%

Annual Cost of Care

Drug Cost

$150

Monitoring

$50

Side Effects

$50

Total Annual

$250

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.05

ICER

$8,000/QALY

Cost per Responder

$357

Treatment Outcomes
Primary Outcomes
Headache Pain Score7/10 (Moderate-Severe)
-64.3% (-4.5 points)
Nausea Severity2/3 (Moderate)
-70% (-1.4 points)
Photophobia Severity2/3 (Moderate)
-70% (-1.4 points)
Secondary Benefits
Functional Impairment8/10 (Severe)
-62.5% (-5 points)
Need for Rescue Medication50% (of patients)
-60% (-30 percentage points)
Headache Recurrence Rate (0-24 hours)60% (of patients experiencing recurrence)
-41.7% (-25 percentage points)
Common Side Effects
Chest tightness/pressure
+5%
Tingling/numbness
+4%
Dizziness
+3%

Clinical Trial Phases:

Phase 4
4
Ubrogepant
75% Effectiveness• 88% Confidence• 70% Safety• 21 trials• 10K participants
HIGH EvidencePoor ValueDose: 50mg or 100mg oral
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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70
DangerousModerateSafe

Time to Effect

1-2 hours

Duration

As needed

Response Rate

55%

Remission Rate

%

Number Needed to Treat (NNT)

8

Common Side Effects:

Nausea: 5%
Somnolence: 3%
Dry mouth: 2%

Annual Cost of Care

Drug Cost

$10,000

Monitoring

$100

Side Effects

$50

Total Annual

$10,150

Cost-Effectiveness

POOR

QALYs Gained

0.06

ICER

$280,000/QALY

Cost per Responder

$18,455

Treatment Outcomes
Primary Outcomes
Pain Intensity Score Reduction at 2 hours2.6 (Average of moderate to severe pain on 0-3 scale)
-34.6% (-0.9 points)
Most Bothersome Symptom (MBS) Severity Reduction at 2 hours2.1 (Average severity of MBS on 0-3 scale)
-33.3% (-0.7 points)
Functional Impairment Score Reduction at 2 hours2.5 (Average of moderate to severe impairment on 0-3 scale)
-32% (-0.8 points)
Secondary Benefits
Work Productivity Impairment Reduction (WPAI-Migraine)50% impairment from migraine
-40% (-20 percentage points)
Allodynia Severity Score Reduction at 2 hours2.0 (Average severity on 0-3 scale)
-25% (-0.5 points)
Common Side Effects
Nausea
+5%
Somnolence
+3%
Dry mouth
+2%

Clinical Trial Phases:

Phase 3Phase 4
5
OnabotulinumtoxinA (Botox)
72% Effectiveness• 90% Confidence• 65% Safety• 63 trials• 9K participants
HIGH EvidenceModerate ValueDose: 155 units injected across 31 sites
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Comparative Safety Scale(Higher is safer)

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Meth💀
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65
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term (every 12 weeks)

Response Rate

48%

Remission Rate

12%

Number Needed to Treat (NNT)

6

Common Side Effects:

Neck pain: 9%
Headache: 5%
Eyelid ptosis: 3%
Muscle weakness: 2%

Annual Cost of Care

Drug Cost

$4,000

Monitoring

$600

Side Effects

$200

Total Annual

$4,800

Cost-Effectiveness

MODERATE

QALYs Gained

0.1

ICER

$100,000/QALY

Cost per Remission

$40,000

Cost per Responder

$10,000

Treatment Outcomes
Primary Outcomes
Headache Days per Month20.7 days/month
-40% (-8.4 days/month)
Migraine Days per Month16.2 days/month
-47% (-7.6 days/month)
Moderate/Severe Headache Days per Month15 days/month
-47% (-7 days/month)
Acute Headache Medication Use Days per Month12.5 days/month
-51% (-6.4 days/month)
Secondary Benefits
Headache Impact Test (HIT-6) ScoreHIT-6 score: 68/78
-9% (-6 points)
Migraine Disability Assessment (MIDAS) ScoreMIDAS score: 110/270+
-32% (-35 points)
SF-36 Role Limitations Due to Physical HealthSF-36 score: 35/100
+51% (+18 points)
Common Side Effects
Neck pain
+9%
Headache
+5%
Eyelid ptosis
+3%

Clinical Trial Phases:

Phase 3Phase 4
6
Topiramate
68% Effectiveness• 90% Confidence• 58% Safety• 67 trials• 30K participants
HIGH EvidenceExcellent ValueDose: 50-100mg daily, titrated
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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58
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term

Response Rate

45%

Remission Rate

10%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

12

Common Side Effects:

Paresthesia: 40%
Cognitive slowing: 20%
Fatigue: 15%
Weight loss: 10%
Kidney stones: 2%

Annual Cost of Care

Drug Cost

$200

Monitoring

$300

Side Effects

$200

Total Annual

$700

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.08

ICER

$25,000/QALY

Cost per Remission

$7,000

Cost per Responder

$1,556

Treatment Outcomes
Primary Outcomes
Migraine Days per Month6 days/month
-45% (-2.7 days/month)
Average Migraine Attack Severity7/10 on Numeric Rating Scale (NRS)
-20% (-1.4 points on NRS)
Acute Migraine Medication Days per Month4 days/month
-40% (-1.6 days/month)
Secondary Benefits
Migraine Disability Assessment Scale (MIDAS) Score40/270
-25% (-10 points on MIDAS)
MSQOL-29 Role Function-Restrictive Score50/100
+15% (+7.5 points on MSQOL-29 RFR)
Body Weight80 kg
-7% (-5.6 kg)
Common Side Effects
Paresthesia
+40%
Cognitive slowing
+20%
Fatigue
+15%

Clinical Trial Phases:

Phase 4
7
Propranolol
65% Effectiveness• 90% Confidence• 62% Safety• 26 trials• 25K participants
HIGH EvidenceExcellent ValueDose: 80-240mg daily, titrated
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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Chemo☢️
Alcohol🍺
Morphine💊
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Exercise🏃
Water💧
62
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Long-term

Response Rate

40%

Remission Rate

8%

Number Needed to Treat (NNT)

8

Common Side Effects:

Fatigue: 15%
Dizziness: 10%
Bradycardia: 8%
Hypotension: 5%
Nausea: 5%

Annual Cost of Care

Drug Cost

$100

Monitoring

$300

Side Effects

$200

Total Annual

$600

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.07

ICER

$20,000/QALY

Cost per Remission

$7,500

Cost per Responder

$1,500

Treatment Outcomes
Primary Outcomes
Migraine Attack Frequency6.5 attacks/month
-45% (-2.9 attacks/month)
Migraine Days per Month10 days/month
-40% (-4.0 days/month)
Migraine Attack Duration11 hours/attack
-25% (-2.75 hours/attack)
Migraine Attack Severity (NRS 0-10)7/10 NRS score
-20% (-1.4 NRS points)
Secondary Benefits
Headache Impact Test (HIT-6) Score60/78 HIT-6 score
-15% (-9 HIT-6 points)
Acute Migraine Medication Use8 days/month
-30% (-2.4 days/month)
Generalized Anxiety Disorder (GAD-7) Score15/21 GAD-7 score
-20% (-3.0 GAD-7 points)
Common Side Effects
Fatigue
+15%
Dizziness
+10%
Bradycardia
+8%

Clinical Trial Phases:

Phase 4