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. 2016 Apr 20;2016(4):CD008541. doi: 10.1002/14651858.CD008541.pub3

Lipton 2009 Study 1.

Study characteristics
Methods Multicentre, R, DB, PC, cross‐over. Single dose per attack. 4 attacks treated: all with active or 3 active and 1 placebo (in random order). Washout between attacks not specified, but all headache medications prohibited within 24 h of a treated attack, and AE data collected for 72 h after treatment
Medication taken within 1 h of onset when PI was mild
Assessments at 0, 2, 4, 24 h
Participants Migraine ± aura (IHS 2004), aged 18 to 65 years. History ≥ 6 months with frequency of 2 to 6 attacks per month and untreated severity ≥ moderate and identifiable mild phase
Excluded: uncontrolled hypertension, cardio‐ or cerebrovascular disease
N = 570 (568 for efficacy)
F = 89%
Mean age 42 years
Interventions Sumatriptan plus naproxen 85/500 mg (1693 attacks treated)
Placebo (424 attacks treated)
5 treatment groups with different medication sequences (Nap: naproxen; P: placebo; Sum: sumatriptan)
P, Sum/Nap, Sum/Nap, Sum/Nap; Sum/Nap, P, Sum/Nap, Sum/Nap; Sum/Nap, Sum/Nap, P, Sum/Nap; Sum/Nap, Sum/Nap, Sum/Nap, P; Sum/Nap, Sum/Nap, Sum/Nap, Sum/Nap
Rescue medication allowed after 2 h if necessary (recommended 2 x 220 mg naproxen sodium with additional 1 x 220 mg 6 h later if needed)
Outcomes Pain‐free at 2 h
24‐h sustained pain‐free
Presence and relief of associated symptoms at 2 h
Use of rescue medication
AEs
Withdrawals
Notes Oxford Quality Score: R1, DB1, W1. Total = 3
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Not described
Allocation concealment (selection bias) Unclear risk Not described
Blinding (performance bias and detection bias)
All outcomes Unclear risk Not described
Incomplete outcome data (attrition bias)
All outcomes Low risk Drop‐outs described
Study size Unclear risk 50 to 200 participants per treatment arm