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PLoS One. 2015 Jul 14;10(7):e0130733. doi: 10.1371/journal.pone.0130733. eCollection 2015.

A Comparative Effectiveness Meta-Analysis of Drugs for the Prophylaxis of Migraine Headache.

Author information

1
General Internal Medicine, Zablocki VA Medical Center, Milwaukee, Wisconsin, United States of America.
2
Department of Medicine, Western Michigan School of Medicine, Kalamazoo, Michigan, United States of America.
3
Division of Hematology and Oncology, University of Washington, Seattle, Washington, United States of America.
4
Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.
5
Department of Pharmacology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.
6
School of Health Sciences, Gollis University, Hergaisa, Somaliland.
7
Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.

Abstract

OBJECTIVE:

To compare the effectiveness and side effects of migraine prophylactic medications.

DESIGN:

We performed a network meta-analysis. Data were extracted independently in duplicate and quality was assessed using both the JADAD and Cochrane Risk of Bias instruments. Data were pooled and network meta-analysis performed using random effects models.

DATA SOURCES:

PUBMED, EMBASE, Cochrane Trial Registry, bibliography of retrieved articles through 18 May 2014.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES:

We included randomized controlled trials of adults with migraine headaches of at least 4 weeks in duration.

RESULTS:

Placebo controlled trials included alpha blockers (n = 9), angiotensin converting enzyme inhibitors (n = 3), angiotensin receptor blockers (n = 3), anticonvulsants (n = 32), beta-blockers (n = 39), calcium channel blockers (n = 12), flunarizine (n = 7), serotonin reuptake inhibitors (n = 6), serotonin norepinephrine reuptake inhibitors (n = 1) serotonin agonists (n = 9) and tricyclic antidepressants (n = 11). In addition there were 53 trials comparing different drugs. Drugs with at least 3 trials that were more effective than placebo for episodic migraines included amitriptyline (SMD: -1.2, 95% CI: -1.7 to -0.82), -flunarizine (-1.1 headaches/month (ha/month), 95% CI: -1.6 to -0.67), fluoxetine (SMD: -0.57, 95% CI: -0.97 to -0.17), metoprolol (-0.94 ha/month, 95% CI: -1.4 to -0.46), pizotifen (-0.43 ha/month, 95% CI: -0.6 to -0.21), propranolol (-1.3 ha/month, 95% CI: -2.0 to -0.62), topiramate (-1.1 ha/month, 95% CI: -1.9 to -0.73) and valproate (-1.5 ha/month, 95% CI: -2.1 to -0.8). Several effective drugs with less than 3 trials included: 3 ace inhibitors (enalapril, lisinopril, captopril), two angiotensin receptor blockers (candesartan, telmisartan), two anticonvulsants (lamotrigine, levetiracetam), and several beta-blockers (atenolol, bisoprolol, timolol). Network meta-analysis found amitriptyline to be better than several other medications including candesartan, fluoxetine, propranolol, topiramate and valproate and no different than atenolol, flunarizine, clomipramine or metoprolol.

CONCLUSION:

Several drugs good evidence supporting efficacy. There is weak evidence supporting amitriptyline's superiority over some drugs. Selection of prophylactic medication should be tailored according to patient preferences, characteristics and side effect profiles.

PMID:
26172390
PMCID:
PMC4501738
DOI:
10.1371/journal.pone.0130733
[Indexed for MEDLINE]
Free PMC Article

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