Unveiling the relative efficacy, safety and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis
He et al. The Journal of Headache and Pain
Unveiling the relative efficacy, safety and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis
Aijie He 3
Dehua Song 2
Lei Zhang 1
Chen Li 0
0 Department of Anesthesia, Yantai Hospital of Traditional Chinese Medicine , No. 39 Xingfu Road, Zhifu Disctrict, 264000 Yantai, Shandong , China
1 Department of Pharmacy, Yantai Hospital of Traditional Chinese Medicine , 264000 Yantai, Shandong , China
2 Department of Radiotherapy, the Affiliated Yantai Yuhuangding Hospital of Qingdao University , 264000 Yantai, Shandong , China
3 Department of Neurosurgery, the Affiliated Yantai Yuhuangding Hospital of Qingdao University , 264000 Yantai, Shandong , China
Background: 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. Methods: We 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. Results: Patients 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. Conclusions: Topiramate, 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.
Migraine; Efficacy; Safety; Tolerability; Network meta-analysis
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Background
Migraine is a chronic neurological disorder with high
prevalence. Females appeared to have a higher morbidity of
migraine than males in developed countries [1]. Although a
relatively small number of migraine cases were reported in
Asia, the morbidity of migraine attack in this region can
reach up to 9.3% [2]. Throbbing headache is usually
accompanied with migraine, resulting in both poor productivity
and unstable emotional state [3, 4]. Migraine patients are
often managed by medications which are convenient and
efficient. However, side effects such as nausea and dizziness
resulted from these medications have been observed in
patients who exhibited poor level of tolerance [5].
Two types of medications have been introduced to
patients: abortive and preventative medications [6]. The
above two types of medications differ considerably in
their mechanisms: abortive treatments attenuate
symptoms arise from acute migraine attacks whereas
preventative medications specifically aim at reducing attack
severity and frequency. Although several prophylactic
medications have been developed for migraine patients,
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
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no consensus has been reached with respect to their
relative efficacy, safety and tolerability [7]. Furthermore,
some medications appear to provide inadequate relief
since they are not effective to all migraine patients [8].
As a result, some meta-analysis has been designed to
compare the relative efficacy between different
medications and some conclusions have been obtained in the
current literature. For instance, patients treated by
sodium valproate were associated with a lower risk of
headache compared to the control group [9].
Furthermore, triptans and non-triptans appear to provide
patients with different levels of relief [10].
Nevertheless, the current literature does not contain
adequate studies that are able to identify the most
preferable prophylactic medication for migraine patients and
there is an increasing demand for discriminating the
availa (...truncated)