Triptans for symptomatic treatment of migraine headache
Bibliographic record
Abstract
A 30 year old woman has debilitating, pulsating right sided headaches up to twice a month for several years. Her pain builds up rapidly and usually lasts 24 hours. She has to lie down during episodes, which are associated with sensitivity to light, severe nausea, and occasional vomiting. Over the counter analgesics such as ibuprofen or paracetamol were initially helpful in relieving pain, but not recently. She asks if any treatments may help with her headaches and allow her to return to her usual activities sooner. Migraine is a common clinical problem, with a global prevalence of 14.7%, and is the eighth most common cause globally of years lived with disability.1 The triptans are selective 5-hydroxytryptamine (5HT) receptor agonists, with high affinity for the 5HT1B and 5HT1D receptors. 5HT1B receptors are on smooth muscle cells of blood vessels and cause vasoconstriction when stimulated. 5HT1D receptors lie on perivascular trigeminal nerve terminals and in the dorsal horn, and their stimulation blocks the release of vasoactive peptides from trigeminal neurones and the release of neurotransmitters in the dorsal horn that convey nociceptive information to the thalamus.2 Seven triptans are commercially available—sumatriptan, naratriptan, zolmitriptan, rizatriptan, eletriptan, frovatriptan, and almotriptan—with minor pharmacokinetic and pharmacodynamic differences between them. Sumatriptan was the first commercially available triptan and has been used in clinical practice since the early 1990s. Several different vehicle delivery systems are available for these drugs, including a subcutaneous injection, nasal spray, rapid melt tablet, and oral tablet (see table⇓ for formulations available, dosages, onset of action, number needed to treat, and drug interactions). View this table: Triptans: pharmacokinetics and NNT for 2 hour pain-free response*† Three systematic reviews of sumatriptan for the acute treatment of migraine were published in the Cochrane Library in 2012. They evaluated the oral tablet,5 …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".