The following is a summary of “Effectiveness and safety of pharmacological prophylaxis for chronic migraine: a systematic review and network meta-analysis,” published in the June 2024 issue of Neurology by Zhao, et al.

Due to the significant impact of Chronic Migraine (CM) on health, researchers aimed to explore the safety and efficacy of various preventive medications.

Researchers conducted a retrospective study and employed a network meta-analysis (NMA) to compare and rank the efficacy and safety of various drugs in preventing CM.

They systematically searched four databases (August 1, 2023), identifying eligible RCTs. Data extraction and evaluated bias risk were conducted. Subsequently, an NMA was executed. Continuous and binary outcomes were presented as weighted mean difference (WMD) and risk ratio (RR), respectively, with corresponding 95% CI. Each intervention was independently ranked using the surface under the cumulative ranking curve (SUCRA).

The results showed 24 RCTs encompassing 8,789 patients; botulinum toxin A significantly reduced monthly migraine days for patients with CM (MD = 3.88, 95% CI 0.48 to 7.28). Topiramate was the most effective in achieving a 50% reduction in monthly migraine days (RR = 50.06, 95% CI 3.18 to 787.30). No significant difference was found between preventive drugs and placebo in improving the migraine disability assessment (MIDAS) score. Eptinezumab demonstrated the highest safety profile regarding AE incidence (RR= 1.09, 95% CI 0.8 to 1.54).

Investigators identified Botulinum toxin A as CM’s most effective and safest preventive medication, followed closely by calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs).

Source: link.springer.com/article/10.1007/s00415-024-12512-z