Effective Migraine Prevention per 215 Trials
Effective Migraine Prevention per 215 Trials
Dear colleagues, my name is Christoph Diener. I am a neurologist at the University of Essen in Germany. Today's topic is prevention of episodic migraines, and the study is from a journal that you usually would not read, the Journal of General Internal Medicine. They recently published a review and meta-analysis of all the randomized controlled trials that were done for the prevention of episodic migraine.
The review is based on 215 randomized controlled trials with 59 drugs. There were 9 trials on topiramate, 3 on valproic acid, 4 each on propranolol and metoprolol, 3 on timolol, and 1 each on angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.
The most important message here is that there are basically no differences in efficacy between these drugs and placebo. Overall, the responder rate -- meaning a reduction in migraine frequency of more than 50% -- was between 200 and 400 per 1000 treated patients. There were significant differences in terms of adverse events. Topiramate, valproic acid, and tricyclic antidepressants had the most adverse events.
One drug, flunarizine, was not mentioned because it is not approved in the United States. Chronic migraine was not addressed because the authors wanted to concentrate on episodic migraine.
This is a very worthwhile publication to read because the authors are experts in systematic reviews and meta-analyses. They have no conflicts of interest because they were never involved in any of the trials on migraine prevention.
The most important point of criticism, however, is that with a few exceptions, most of the trials that were done in the past were of poor quality. They were underpowered and had major problems with trial design. The only properly conducted trials recently were the trials on topiramate.
Ladies and gentlemen, this is a very important publication that tells us which drugs are most probably effective in the prevention of episodic migraine and which drugs are not. I am Christoph Diener, a stroke neurologist from the University of Essen in Germany. Thank you for listening.
Dear colleagues, my name is Christoph Diener. I am a neurologist at the University of Essen in Germany. Today's topic is prevention of episodic migraines, and the study is from a journal that you usually would not read, the Journal of General Internal Medicine. They recently published a review and meta-analysis of all the randomized controlled trials that were done for the prevention of episodic migraine.
The review is based on 215 randomized controlled trials with 59 drugs. There were 9 trials on topiramate, 3 on valproic acid, 4 each on propranolol and metoprolol, 3 on timolol, and 1 each on angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers.
The most important message here is that there are basically no differences in efficacy between these drugs and placebo. Overall, the responder rate -- meaning a reduction in migraine frequency of more than 50% -- was between 200 and 400 per 1000 treated patients. There were significant differences in terms of adverse events. Topiramate, valproic acid, and tricyclic antidepressants had the most adverse events.
One drug, flunarizine, was not mentioned because it is not approved in the United States. Chronic migraine was not addressed because the authors wanted to concentrate on episodic migraine.
This is a very worthwhile publication to read because the authors are experts in systematic reviews and meta-analyses. They have no conflicts of interest because they were never involved in any of the trials on migraine prevention.
The most important point of criticism, however, is that with a few exceptions, most of the trials that were done in the past were of poor quality. They were underpowered and had major problems with trial design. The only properly conducted trials recently were the trials on topiramate.
Ladies and gentlemen, this is a very important publication that tells us which drugs are most probably effective in the prevention of episodic migraine and which drugs are not. I am Christoph Diener, a stroke neurologist from the University of Essen in Germany. Thank you for listening.
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