[Pharmacological treatment of migraines. Qualitative study]

Garcia Monco J C, Alvarez de Arcaya A, Eguia del Rio P, Etxebarria Ibanez I, Gonzalez Hernandez N, Ruiz de Velasco Artaza I
Record ID 32003000017
Original Title: Revisión sobre el tratamiento farmacológico de la migraña y estudio cualitativo
Authors' objectives: The aims of this report were to review the pharmacological treatments of migraines that have been studied in controlled clinical trials and that therefore have a basis for being indicated in the treatment of migraines, and to create a number of clinical practice recommendations for treating migraine sufferers in our environment.
Authors' results and conclusions: During the period 1997-2000, a total of 40 controlled clinical trials in symptomatic treatments of migraines were identified (of these, twelve analysed several migraine attacks) and four relating to preventive treatment. The average primary efficiency used in the majority of surveys which analysed symptomatic treatments was the percentage of patients with a reduction in the intensity from moderate to severe pain to slight to negligible pain. In the case of preventive treatment, the primary efficiency variable was the reduction in the monthly frequency of headaches. Twenty-one trials compared a triptan to a placebo (oral, nasal and subcutaneous sumatriptan; zolmitriptan; oral and sublingual rizatriptan; almotriptan and avitriptan) and another six established comparisons between two triptans (zolmitriptan with sumatriptan and rizatriptan; naratriptan with sumatriptan and rizatriptan and eltriptan with sumatriptan). The remaining surveys on symptomatic treatment focused on the use of painkillers and anti-inflammatory drugs. An assessment was made of the efficiency of sodium valproate, lamotrigine, gabapentine and bisoprolol.
Authors' recommendations: In the different forms they are administered, all the triptans are efficient and well tolerated in the treatment of migraine attacks of a moderate to severe nature. In the case of nauseas and vomiting, the subcutaneous nasal or wafer method may be used. Non steroidal anti-inflammatory drugs can be considered to be first line medicines for treating slight to moderate intensity migraines. Should the establishment of preventive treatment be considered necessary, beta-blockers would be a first line option, and calcium antagonists or anticomicals such as calcium valproate would be acceptable options.
Authors' methods: Basing ourselves on the work done by the Duke University´s Center for Clinical Health Policy Research (CCHPR), which made a systematic review of controlled clinical trials on the symptomatic and preventive treatment of migraines, published between 1966 and 1996, the survey was extended from 1997 to 2000. After a search made of MEDLINE using the keyword “migraine” and a search strategy of controlled clinical trials (Dickersin et al. 1994), the prospective, controlled and randomised surveys published in English were included, and an appraisal was made of their methodological quality, using the scale conceived by Jadad et al (1996).
Project Status: Completed
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Spain
MeSH Terms
  • Migraine Disorders
  • Migraine Disorders
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus
Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.