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Clinical effectiveness of pharmacological interventions for managing chronic migraine in adults : a systematic review and network meta-analysis
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Naghdi, Seyran, Underwood, Martin, Madan, Jason, Brown, Anna, Duncan, Callum, Matharu, Manjit, Aksentyte, Aiva, Davies, Natasha, Rees, Sophie, Cooklin, Andrew, Grove, Amy L. and Mistry, Hema (2023) Clinical effectiveness of pharmacological interventions for managing chronic migraine in adults : a systematic review and network meta-analysis. The Journal of Headache and Pain, 24 (1). 164. doi:10.1186/s10194-023-01696-w ISSN 1129-2377.
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Official URL: https://doi.org/10.1186/s10194-023-01696-w
Abstract
Background: Chronic migraine can be a profoundly disabling disorder that may be treated with preventive medications. However, uncertainty remains as to which preventive medication is the most effective. We present a network meta-analysis to determine the effectiveness and rank of preventive drugs for chronic migraine in adults. Methods: We identified, reviewed, and extracted data from randomised controlled trials (RCTs) of preventive drugs for chronic migraine with at least 200 participants. Data were analysed using network meta-analysis. Findings: We included 12 RCTs of six medications (Eptinezumab, Erenumab, Fremanezumab, Galcanezumab, Onabotulinumtoxin A, and Topiramate) compared to placebo or each other. All drugs effectively reduced monthly headache and migraine days compared with placebo. The most effective drug for monthly headache days was Eptinezumab 300mg, with a mean difference of -2.46 days, 95% Credible Interval (CrI): -3.23 to -1.69. On the Surface Under the Cumulative Ranking Area (SUCRA) analysis, the probability that Eptinezumab 300mg was ranked highest was 0.82. For monthly migraine days, the most effective medication was Fremanezumab-monthly, with a mean difference: -2.77 days, 95% CrI: -3.36 to -2.17, and 0.98 probability of being ranked the highest. All included drugs, except Topiramate, improved headache-related quality of life. No eligible studies were identified for the other common preventive oral medications such as Amitriptyline, Candesartan, and Propranolol. The main reasons were that the studies did not define chronic migraine, were undertaken before the definition of chronic migraine, or were too small. Interpretation: All six medications were more effective than the placebo on monthly headache and migraine days. The absolute differences in the number of headache/migraine days are, at best, modest. No evidence was found to determine the relative effectiveness of the six included drugs with other oral preventive medications. Registration: PROSPERO (number CRD42021265990).
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||
SWORD Depositor: | Library Publications Router | ||||||
Library of Congress Subject Headings (LCSH): | Migraine -- Treatment, Headache -- Treatment, Meta-analysis, Medicine, Preventive | ||||||
Journal or Publication Title: | The Journal of Headache and Pain | ||||||
Publisher: | Springer Milan | ||||||
ISSN: | 1129-2377 | ||||||
Official Date: | 6 December 2023 | ||||||
Dates: |
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Volume: | 24 | ||||||
Number: | 1 | ||||||
Article Number: | 164 | ||||||
DOI: | 10.1186/s10194-023-01696-w | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 7 December 2023 | ||||||
Date of first compliant Open Access: | 12 December 2023 | ||||||
RIOXX Funder/Project Grant: |
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