Comprehensive preventive treatments for episodic migraine: a systematic review of randomized clinical trials
Abstract
Background: Episodic migraine is a prevalent and disabling neurological disorder with a significant impact on quality of life and productivity. Preventive treatment aims to reduce the frequency, intensity, and disability associated with migraine attacks. However, the comparative efficacy and safety of available preventive strategies remain insufficiently addressed in the literature, especially in low- and middle-income countries.
Objective: To evaluate the efficacy and safety of pharmacological and non-pharmacological preventive treatments for episodic migraine through a systematic review and meta-analysis of randomized controlled trials (RCTs).
Methods: Following PRISMA guidelines, a comprehensive literature search was conducted across Wiley Online, BVS, MEDLINE, and OVID databases through November 2024. Eligible studies were RCTs comparing preventive treatments with placebo or active comparators in adults with episodic migraine. This review was not registered in PROSPERO due to institutional constraints at the time of project initiation. Primary outcomes included changes in monthly migraine days (MMD), monthly headache days (MHD), acute medication days (AMD), adverse events (AE) and serious adverse events (SAE). Meta-analysis was performed using fixed- or random-effects models depending on heterogeneity.
Results: Thirty-nine RCTs involving over 15,000 patients were included. Anti-CGRP monoclonal antibodies and gepants demonstrated the most consistent reduction in MMD (-3.2…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 15,000 participants or records.
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