Unveiling the relative efficacy, safety and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis

The Journal of Headache and Pain

Research Article

Chen Li¹  Aijie He²  Lei Zhang³  Dehua Song⁴ 

[1] Department of Anesthesia, Yantai Hospital of Traditional Chinese Medicine, No. 39 Xingfu Road, Zhifu Disctrict, 264000, Yantai, Shandong, China;Department of Neurosurgery, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, 264000, Yantai, Shandong, China;Department of Pharmacy, Yantai Hospital of Traditional Chinese Medicine, 264000, Yantai, Shandong, China;Department of Radiotherapy, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, 264000, Yantai, Shandong, China;

关键词: Migraine;    Efficacy;    Safety;    Tolerability;    Network meta-analysis;   

DOI  :  10.1186/s10194-017-0720-7

 received in 2016-11-14, accepted in 2017-01-06,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundA large number patients struggle with migraine which is classified as a chronic disorder. The relative efficacy, safety and tolerability of prophylactic medications for migraine play a key role in managing this disease.MethodsWe conducted an extensive literature search for popular prophylactic medications that are used for migraine patients. Pairwise meta-analysis and network meta-analysis (NMA) were carried out sequentially for determining the relative efficacy, safety and tolerability of prophylactic medications. Summary effect for migraine headache days, headache frequency, at least 50% reduction in headache attacks, all-adverse events, nausea, somnolence, dizziness, withdrawal and withdrawal due to adverse events were produced by synthesizing both direct and indirect evidence.ResultsPatients with three interventions exhibited significantly less average migraine headache days compared with those treated by placebo (topiramate, propranolol, divalproex). Moreover, topiramate and valproate exhibited a significantly increased likelihood of at least 50% reduction in migraine headache attacks compared to placebo. Patients with topiramate and propranolol also exhibited significantly reduced headache frequency compared to those with placebo. On the other hand, patients with divalproex exhibited significantly higher risk of nausea compared to those with placebo, topiramate, propranolol, gabapentin and amitriptyline. Finally, divalproex was associated with an increased risk of withdrawal compared to placebo and propranolol.ConclusionsTopiramate, propranolol and divalproex may be more efficacious than other prophylactic medications. Besides, the safety and tolerability of divalproex should be further verified by future studies.

【 授权许可】

CC BY   
© The Author(s). 2017