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Table 22Treatment discontinuation due to adverse effects with migraine preventive drugs in adults, evidence from meta-analyzed randomized controlled clinical trials

Active Preventive TreatmentSampleRate, Percent With Drug [Control]Relative Risk (95% CI)Absolute Risk Difference (95% CI)Number Needed To Treat (95% CI)Attributable Events per 1,000 Treated (95% CI)Strength of Evidence Reasons for Lowering SOE
Compared With Placebo
Chronic Migraine
Onabotulinumtoxin A137,25113843.8 [1.1]3.2 (1.4 to 7.1)0.03 (0.01 to 0.04)38 (23 to 100)26 (10 to 43)Moderate (medium ROB)
Episodic Migraine
Topiramate27,85,96, 99,146,148,150,252205516.6 [8.5]1.8 (1.3 to 2.4)0.06 (0.02 to 0.11)16(9 to 53)63(19 to 107)Low (medium ROB, Imprecise)
Divalproex101,1023469.8 [7.8]1.2 (0.5 to 2.7)0.02 (−0.05 to 0.10)NSNSLow (medium ROB, Imprecise, Inconsistent)
Valproate120,1531506.7 [5.3]1.3 (0.3 to 4.9)0.01 (−0.07 to 0.08)NSNSLow (medium ROB, Imprecise)
Propranolol106,23822113.2 [5.6]2.1 (0.6 to 7.7)0.06 (0.00 to 0.12)16 (8 to 333)62 (3 to 120)Low (medium ROB, Imprecise, Inconsistent)
Gabapentin87,110,11127017.0 [7.7]1.9 (0.9 to 4.2)0.07 (−0.01 to 0.15)NSNSLow (medium ROB, Imprecise)
Lamotrigine99,24017812.8 [6.0]2.4 (0.5 to 12.2)0.14 (−0.17 to 0.44)NSNSLow (Imprecise, Inconsistent)
Amitriptyline125,25350711.2 [5.8]1.9 (1.0 to 3.5)0.05 (0.01 to 0.10)19 (10 to 167)54 (6 to 102)Low (medium ROB, Imprecise)
Femoxetine167,16812411.7 [6.3]1.9 (0.6 to 6.1)0.05 (−0.05 to 0.15)NSNSLow (medium ROB, Imprecise)
Clonidine177,2543342.4 [0.6]2.8 (0.4 to 18.5)0.02 (−0.01 to 0.05)NSNSLow (medium ROB, Imprecise)
Nimodipine112,2441553.9 [6.3]0.7 (0.2 to 2.6)−0.03 (−0.09 to 0.04)NSNSLow (medium ROB, Imprecise, Inconsistent)
Naproxen246,2551723.5 [1.2]2.3 (0.3 to 15.4)0.02 (−0.03 to 0.07)NSNSLow (High ROB, Imprecise, Inconsistent)
Magnesium115,1161507.7 [1.4]3.8 (0.7 to 22.4)0.06 (0.00 to 0.13)NSNSLow (Inconsistent Imprecise)
Compared With Active Treatment, Episodic Migraine
Topiramate vs. amitriptyline189,24739918.3 [21.3]0.9 (0.6 to 1.3)−0.04 (−0.11 to 0.04)NSNSLow (medium ROB, imprecision)

CI = confidence interval; ROB = risk of bias; SOE = strength of evidence; NS = not significant

Number needed to treat and number of attributable events were calculated for statistically significant differences.

From: Results

Cover of Migraine in Adults: Preventive Pharmacologic Treatments
Migraine in Adults: Preventive Pharmacologic Treatments [Internet].
Comparative Effectiveness Reviews, No. 103.
Shamliyan TA, Kane RL, Taylor FR.

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