Table 14Comparative effectiveness of drugs for migraine prevention in adults with episodic migraine, direct evidence from head-to-head randomized controlled clinical trials (pooled with random effects model)

Active Preventive Treatment ReferencesOutcomeSampleRate, Percent With Active [Control] DrugRelative 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
Timolol vs. Propranolol104,107≥50% decrease in migraine frequency24247.9 [52.1]1.0 (0.7 to 1.2)−0.03(−0.15 to 0.10)NSNSLow (medium ROB, imprecision)
p value0.5930.606
I squared00
Propranolol vs. Metoprolol194,195≥50% decrease in migraine frequency11338.2 [50.0]0.8 (0.5 to 1.2)−0.12 (−0.30 to 0.06)NSNSLow (medium ROB, imprecision)
p valuep = 0.371p = 0.361
I squared00
Propranolol vs. Nifedipine195,196≥50% decrease in migraine frequency7646.2 [18.9]2.3 (1.1 to 4.6)0.27 (0.09 to 0.46)4 (2 to 11)274 (89 to 458)Low (high ROB, imprecision)
Metoprolol vs. Aspirin202,203≥50% decrease in migraine frequency32633.1 [39.3]1.6 (0.2 to 11.0)0.11 (−0.43 to 0.65)NSNSLow (medium ROB, imprecision)
p value0.0010
I squared0.9070.948

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

Bold = significant effects of drugs on treatment response when 95% CI of attributable events per 1,000 treated do not include 0. 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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