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

摘要: 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 quality was assessed using both JADAD Cochrane Risk Bias instruments. pooled meta-analysis random models. Sources PUBMED, EMBASE, Trial Registry, bibliography retrieved articles through 18 May 2014. Eligibility Criteria for Selecting Studies included randomized controlled trials adults with headaches at least 4 weeks duration. Results Placebo alpha blockers (n = 9), angiotensin converting enzyme inhibitors 3), receptor anticonvulsants 32), beta-blockers 39), calcium channel 12), flunarizine 7), serotonin reuptake 6), norepinephrine 1) agonists 9) tricyclic antidepressants 11). In addition there 53 comparing different drugs. Drugs 3 that more effective than placebo episodic migraines amitriptyline (SMD: -1.2, 95% CI: -1.7 to -0.82), -flunarizine (-1.1 headaches/month (ha/month), -1.6 -0.67), fluoxetine -0.57, -0.97 -0.17), metoprolol (-0.94 ha/month, -1.4 -0.46), pizotifen (-0.43 -0.6 -0.21), propranolol (-1.3 -2.0 -0.62), topiramate -1.9 -0.73) valproate (-1.5 -2.1 -0.8). Several drugs less included: ace (enalapril, lisinopril, captopril), two (candesartan, telmisartan), (lamotrigine, levetiracetam), several (atenolol, bisoprolol, timolol). Network found be better other medications including candesartan, fluoxetine, propranolol, no atenolol, flunarizine, clomipramine or metoprolol. Conclusion good evidence supporting efficacy. There is weak amitriptyline’s superiority over some Selection medication should tailored according patient preferences, characteristics effect profiles.