Evidence map›Paper›PMID 37208596›Full record

SynthesisThe journal of headache and pain2023

The comparative effectiveness of migraine preventive drugs: a systematic review and network meta-analysis.

Christian Lampl, Antoinette MaassenVanDenBrink, Christina I Deligianni, Raquel Gil-Gouveia, Tanvir Jassal, Margarita Sanchez-Del-Rio, Uwe Reuter, Derya Uluduz, Jan Versijpt, Dena Zeraatkar and 1 more

Open access · goldAbstract readSystematic ReviewNetwork Meta-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 75 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
75citing papers in PubMed, 12 pooled it
26.7field-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

75 citing papers in PubMed, 12 syntheses or guidelines pooled it, 120 citations in OpenAlex.

  1. Pooled it
  2. Migraine management in Saudi Arabia: An expert consensus.Neurosciences (Riyadh, Saudi Arabia) · 2025
    Guideline
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15 more citing papers are in PubMed but not listed here.

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

11 authors at 9 institutions in 9 countries.

Christian Lampl *Department of Neurology, Konventhospital Barmherzige Brüder Linz, Linz, Austria. christian.lampl@bblinz.at.
Antoinette MaassenVanDenBrink *Department of Internal Medicine, Erasmus MC Medical Center, Rotterdam, The Netherlands.
Christina I DeligianniDepartment of Neurology, Athens Naval Hospital, Athens, Greece.
Raquel Gil-GouveiaNeurology Department, Hospital da Luz Headache Center, Hospital da Luz Lisboa, Lisbon, Portugal.
Tanvir JassalDepartment of Anesthesia and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
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.
Jan VersijptDepartment of Neurology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
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.
McMaster University · CAAthens Naval & Veterans Hospital · GRCharité - Universitätsmedizin Berlin · DEClinica Universidad de Navarra · ESConvent Hospital of the Brothers of Saint John of God · ATErasmus MC · NLUniversidade Católica Portuguesa · PTUniversity of L'Aquila · ITVrije Universiteit Brussel · BE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveWhile there are several trials that support the efficacy of various drugs for migraine prophylaxis against placebo, there is limited evidence addressing the comparative safety and efficacy of these drugs. We conducted a systematic review and network meta-analysis to facilitate comparison between drugs for migraine prophylaxis.

methodsWe searched MEDLINE, EMBASE, CENTRAL, and clinicaltrials.gov from inception to August 13, 2022, for randomized trials of pharmacological treatments for migraine prophylaxis in adults. Reviewers worked independently and in duplicate to screen references, extract data, and assess risk of bias. We performed a frequentist random-effects network meta-analysis and rated the certainty (quality) of evidence as either high, moderate, low, or very low using the GRADE approach.

resultsWe identified 74 eligible trials, reporting on 32,990 patients. We found high certainty evidence that monoclonal antibodies acting on the calcitonin gene related peptide or its receptor (CGRP(r)mAbs), gepants, and topiramate increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, compared to placebo. We found moderate certainty evidence that beta-blockers, valproate, and amitriptyline increase the proportion of patients who experience a 50% or more reduction in monthly migraine days, and low certainty evidence that gabapentin may not be different from placebo. We found high certainty evidence that, compared to placebo, valproate and amitriptyline lead to substantial adverse events leading to discontinuation, moderate certainty evidence that topiramate, beta-blockers, and gabapentin increase adverse events leading to discontinuation, and moderate to high certainty evidence that (CGRP(r)mAbs) and gepants do not increase adverse events.

conclusions(CGRP(r)mAbs) have the best safety and efficacy profile of all drugs for migraine prophylaxis, followed closely by gepants.

Indexed as

Migraine DisordersValproic AcidAdultAmitriptylineAntibodies, MonoclonalCalcitonin Gene-Related PeptideGabapentinHumansTopiramateAmitriptylineAntibodies, MonoclonalCalcitonin Gene-Related PeptideGabapentinTopiramateValproic AcidCGRP monoclonal antibodiesMigraineNetwork meta-analysisSystematic review

Identifiers

PMID37208596
PMCPMC10197489
OpenAlexW4377097120

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.