Evidence map›Paper›PMID 37038134›Full record

SynthesisThe journal of headache and pain2023

European Headache Federation (EHF) critical re-appraisal and meta-analysis of oral drugs in migraine prevention-part 1: amitriptyline.

Christian Lampl, Jan Versijpt, Faisal Mohammad Amin, Christina I Deligianni, Raquel Gil-Gouveia, Tanvir Jassal, Antoinette MaassenVanDenBrink, Raffaele Ornello, Jakob Paungarttner, Margarita Sanchez-Del-Rio and 5 more

Open access · goldAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The journal of headache and pain, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 5 pooled it
9.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 5 syntheses or guidelines pooled it, 41 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Review
  7. Article
  8. Article
  9. Drugs for Migraine Prophylaxis.Deutsches Arzteblatt international · 2026
    Review
  10. Review
  11. Article
  12. Review
  13. Review
  14. Review
  15. Migraine and Its Treatment from the Medicinal Chemistry Perspective.ACS pharmacology & translational science · 2024
    Review
  16. Article
  17. Review
  18. Article
  19. Health equity, care access and quality in headache - part 2.The journal of headache and pain · 2023
    Review
  20. Migraine, Allergy, and Histamine: Is There a Link?Journal of clinical medicine · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 10 institutions in 10 countries.

Christian LamplDepartment of Neurology and Stroke Unit, Konventhospital Barmherzige Brüder Linz, Linz, Austria. christian.lampl@bblinz.at.
Jan Versijpt *Department of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
Faisal Mohammad AminDanish Headache Center, Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark.
Christina I DeligianniDepartment of Neurology, Athens Naval Hospital, Athens, Greece.
Raquel Gil-GouveiaHospital da Luz Headache Center, Neurology Department, Hospital da Luz Lisboa, Lisbon, Portugal.
Tanvir JassalDepartment of Anesthesia and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Antoinette MaassenVanDenBrink *Department of Internal Medicine, Erasmus MC Medical Center, Rotterdam, The Netherlands.
Raffaele Ornello *Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Jakob Paungarttner *Headache Medical Center Linz, Linz, Austria.
Margarita Sanchez-Del-RioDepartment of Neurology, Clinica Universidad de Navarra, Madrid, Spain.
Uwe ReuterDepartment of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Derya UluduzDepartment of Neurology Istanbul Cerrahpasa Medical Faculty, Istanbul, Turkey.
Tessa de Vries *Department of Internal Medicine, Erasmus MC Medical Center, Rotterdam, The Netherlands.
Dena Zeraatkar *Department of Anesthesia and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Simona Sacco *Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Erasmus MC · NLMcMaster University · CAUniversity of L'Aquila · ITAthens Naval & Veterans Hospital · GRCharité - Universitätsmedizin Berlin · DEClinica Universidad de Navarra · ESHospital da Luz · PTLinz Center of Mechatronics (Austria) · ATRigshospitalet · DKUniversitair Ziekenhuis Brussel · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe aim of this paper is to critically re-appraise the published trials assessing amitriptyline for migraine prophylaxis.

methodsWe report our methods and results following the Preferred Reporting Items for Systematic Reviews (PRISMA), by searching MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov for randomized trials of pharmacologic treatments for migraine prophylaxis. We included randomized trials that compared amitriptyline with placebo for migraine prophylaxis in adults. Our outcomes of interest were informed by the Outcome Set for preventive intervention trials in chronic and episodic migraine (COSMIG) and include the proportion of patients who experience a 50% or more reduction in migraine days per month, migraine days per month, and adverse events leading to discontinuation. We assessed risk of bias by using a modified Cochrane RoB 2.0 tool and the certainty of evidence by using the GRADE approach.

resultsOur search yielded 10.826 unique records, of which three trials (n = 622) were eligible for data synthesis and analysis. We found moderate certainty evidence that amitriptyline increases the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo (relative risk: 1.60 (95% CI 1.17 to 2.19); absolute risk difference: 165 more per 1,000 (95% CI 47 more to 327 more). We found moderate certainty evidence that amitriptyline increases the proportion of patients who discontinue due to adverse events compared to placebo (risk difference: 0.05 (95% CI 0.01 to 0.10); absolute risk difference: 50 more per 1,000 (95% CI 10 more to 100 more).

conclusionsOur meta-analysis showed that amitriptyline may have a prophylactic role in migraine patients, however these results are far from robust. This warrants further large-scale research to evaluate the role of amitriptyline in migraine prevention.

Indexed as

AmitriptylineMigraine DisordersAdultHeadacheHumansTranscription FactorsAmitriptylineEHF protein, humanTranscription FactorsAmitriptylineMeta-analysisMigraineProphylactic treatment

Identifiers

PMID37038134
PMCPMC10088191
OpenAlexW4363678756

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.