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Meta-analysis of the Efficacy and Safety of Drugs in the Prophylaxis of Migraine

Author: GuoYiYi
Tutor: YuTingMin
School: Jilin University
Course: Clinical
Keywords: Propranolol Topiramate Valproate Meta-analysis Migraine Prophylaxis
CLC: R747.2
Type: Master's thesis
Year: 2012
Downloads: 117
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Abstract


Background and objectives:Migraine is a chronic reoccurring nerve system disorder. Treatment ofmigraine including symptomatic therapy during the headache phase andprophylactic therapy during the the chronic phase. Prophylaxis therapyincluding pharmacologic therapies and other prophylaxis therapies. Calciumantagonists,β-blockers, antiepileptics, antidepressants, vitamins, minerals andherbal agents are common prophylactic drugs. We performed a meta-analysisto determine the relative effectiveness and safety of propranolol, topiramateand valproate compared with placebo for the prevention of migraine attacks,and provide a foundation for clinical practice.Materials and methods：Databases, including Medline, Embase, CNKI （1988.1-2011.6）,andCochrane Library, CALIS （1997.1-2011.6） were searched for clinicalrandomized controlled trials. Trails were included according to the inclusionand exclusion criteria, and assessed in terms of the improved Jadad scores andextracted data. Meta-analyses were performed using RevMan5.1software. Thepossibility of publication bias was assessed by evaluating a funnel plot.Results：1.Propanolol: A total of8RCTs were enrolled in present meta-analysis.The results of Meta-analysis showed: the responder rate of propranolol inmigraine prophylaxis was higher than placebo[OR=2.13，95%C（I1.45，3.14）],but lower than flunarinze[OR=0.69，95%CI（0.36，1.32）]. The incidence rate of adverse effects was higher than placebo（p<0.00001）,most of which werelight to moderate.2.Topiramate: A total of8RCTs were included in the meta-analysis. Theresults of Meta-analysis showed: the responder rate in both topiramate100mg/dand200mg/d were higher than placebo[OR=2.97，95%CI（2.17，4.08） andOR=2.35,,95%CI（1.77,3.12）respectively]. The change of mean monthlymigraine days in topiramate100mg/d was higher than placebo [MD-1.14,95%CI（-1.69，-0.59）]. The incidence rate of adverse effects was higher thanplacebo（p<0.001）,most of which were light to moderate.3.Valproate: A total of7RCTs were included in the meta-analysis. Theresults of Meta-analysis showed: the responder rate in valproate wassignificantly higher than placebo［OR=2.57，95%C（I1.13，5.82），P=0.02］,anda little lower than propranolol［OR=0.79，95%CI（0.44，1.40），P=0.41］，but not significantly. The incidence rate of adverse effects were similar toplacebo(p=0.30).Conclusions:1. Propanolol is more effective than placebo and as effective as flunarizine,generally safe in the prophylaxis of migraine.2. Topiramate is more effective than placebo and generally safe for theprophylaxis of migraine.3. Valproate is more effective than placebo and as effective as propranolol,also safe for migraine prophylaxis.

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CLC: > Medicine, health > Neurology and psychiatry > Neurology > Autonomic nervous system diseases > Migraine
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