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P.067 Pharmacological prophylaxis for chronic migraine: A systematic review and network meta-analysis of randomized controlled trials

Published online by Cambridge University Press:  24 May 2024

M Khalili
Affiliation:
(Hamilton)*
A Liaghatdar
Affiliation:
(Isfahan)
F Mahdian
Affiliation:
(Sari)
T Levit
Affiliation:
(Hamilton)
S Moradi
Affiliation:
(Hamilton)
E Hedayati
Affiliation:
(Ahvaz)
K Torabiardakani
Affiliation:
(Hamilton)
F Ahmadi
Affiliation:
(Shiraz)
S Khademioore
Affiliation:
(Hamilton)
A Sofi-Mahmudi
Affiliation:
(Hamilton)
T Atkin-Jones
Affiliation:
(Hamilton)
V Patil
Affiliation:
(Hamilton)
F Mirzayeh Fashami
Affiliation:
(Hamilton)
S Mehmandoost
Affiliation:
(Kerman)
S Sharma
Affiliation:
(Hamilton)
M Fereshtehnejad
Affiliation:
(Toronto)
J Busse
Affiliation:
(Hamilton)
B Sadeghirad
Affiliation:
(Hamilton)
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Abstract

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Background: We performed a network meta-analysis of randomized controlled trials to assess the comparative effectiveness of available pharmacological prophylaxis for migraines. Methods: We searched MEDLINE, EMBASE, Web of Science, Scopus, PsycINFO and Cochrane CENTRAL up to October 2023 for trials that: (1) enrolled adults diagnosed with chronic migraine, and (2) randomized them to any prophylactic medication vs. another medication or placebo. We performed a random-effects frequentist network meta-analysis for patient-important outcomes. Results: We included 193 randomized trials. Compared to placebo, CGRP monoclonal antibodies (mean difference [MD] -1.7, 95%CI: -1.1 to -2.2), injection of botulinum toxin (MD -1.8, 95%CI: -0.7 to -2.9), calcium channel blockers (MD -1.8, 95%CI: -0.5 to -3.0), beta-blockers (MD -1.4, 95%CI: -0.2 to -2.6), and anticonvulsants (MD -1.1, 95%CI: -0.4 to -1.8) were among the most effective treatments in reducing average number of headache days per months. Anticonvulsants (Risk Ratio [RR] 2.3, 95%CI: 1.8 to 3.0), calcium channel blockers (RR 1.8, 95% CI: 1.1 to 3.1), and tricyclic antidepressants (RR 2.3, 95% CI: 1.3 to 3.8) showed the highest risk of discontinuation due to adverse events. Conclusions: Our findings suggest that CGRP inhibitors, botulinum toxin, and beta-blockers may provide the greatest benefit, and tolerability, for reducing the frequency of migraine headaches.

Type
Abstracts
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation