Drug Treatments for the Prevention of Migraine Headache. Technical Review 2.3

摘要

This report identifies and summarizes evidence from full reports of controlled211u001etrials published from 1966 to 1996 on the efficacy and tolerability of drug 211u001etreatments for the prevention of migraine headache. The classes of drug 211u001etreatments studied are: alpha-2 agonists (16 trials), anticonvulsants (9 trials), 211u001eantidepressants (16 trials), beta-blockers (74 trials), calcium antagonists (45 211u001etrials), ergots (13 trials), methysergide (16 trials), nonsteroidal anti-211u001einflammatory drugs (NSAIDs' 23 trials), other serotoninergic agents (40 trials), 211u001eand other treatments (8 trials). Drugs with multiple placebo-controlled trials 211u001esuggesting at least moderate efficacy include propranolo, timolol, sodium 211u001evaproate and divalproex sodium, naproxen sodium, amitriptyline, methysergide, 211u001eflunarizine, pizotifen, and lisuride. Within more diverse drug categories--such 211u001eas antidepressents, calcium antagonists, and anticonvulsants--there was more 211u001evariability in the efficacy of different agents. Many efficacious preventive 211u001edrugs were poorly tolerated, thereby limiting their usefulness, and were 211u001eassociated with substantial rates of patient withdrawals. The researchers 211u001econcluded that, although several specific agents have been shown to be 211u001eefficacious for the prevention of migraine, there are few data to guide the 211u001echoice among agents.