Abstract
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.
Highlights
A large number patients struggle with migraine which is classified as a chronic disorder
Several prophylactic medications have been developed for migraine patients, He et al The Journal of Headache and Pain (2017) 18:26 no consensus has been reached with respect to their relative efficacy, safety and tolerability [7]
The majority of the included studies belonged to typical randomized controlled trials (RCTs), we identified and included five crossover RCTs in which participants were randomized to receive a sequence of interventions
Summary
A 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. The above two types of medications differ considerably in their mechanisms: abortive treatments attenuate symptoms arise from acute migraine attacks whereas preventative medications aim at reducing attack severity and frequency. Several prophylactic medications have been developed for migraine patients, He et al The Journal of Headache and Pain (2017) 18:26 no consensus has been reached with respect to their relative efficacy, safety and tolerability [7]. Some medications appear to provide inadequate relief since they are not effective to all migraine patients [8]. Some meta-analysis has been designed to compare the relative efficacy between different medications and some conclusions have been obtained in the current literature. Triptans and non-triptans appear to provide patients with different levels of relief [10]
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