Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis

Abstract

BackgroundHeadaches are a common source of pain and suffering. The study’s purpose was to assess beta-blockers efficacy in preventing migraine and tension-type headache.MethodsCochrane Register of Controlled Trials; MEDLINE; EMBASE; ISI Web of Science, clinical trial registries, CNKI, Wanfang and CQVIP were searched through 21 August 2018, for randomized trials in which at least one comparison was a beta-blocker for the prevention of migraine or tension-type headache in adults. The primary outcome, headache frequency per month, was extracted in duplicate and pooled using random effects models.Data synthesisThis study included 108 randomized controlled trials, 50 placebo-controlled and 58 comparative effectiveness trials. Compared to placebo, propranolol reduced episodic migraine headaches by 1.5 headaches/month at 8 weeks (95% CI: -2.3 to -0.65) and was more likely to reduce headaches by 50% (RR: 1.4, 95% CI: 1.1–1.7). Trial Sequential Analysis (TSA) found that these outcomes were unlikely to be due to a Type I error. A network analysis suggested that beta-blocker’s benefit for episodic migraines may be a class effect. Trials comparing beta-blockers to other interventions were largely single, underpowered trials. Propranolol was comparable to other medications known to be effective including flunarizine, topiramate and valproate. For chronic migraine, propranolol was more likely to reduce headaches by at least 50% (RR: 2.0, 95% CI: 1.0–4.3). There was only one trial of beta-blockers for tension-type headache.ConclusionsThere is high quality evidence that propranolol is better than placebo for episodic migraine headache. Other comparisons were underpowered, rated as low-quality based on only including single trials, making definitive conclusions about comparative effectiveness impossible. There were few trials examining beta-blocker effectiveness for chronic migraine or tension-type headache though there was limited evidence of benefit.RegistrationProspero (ID: CRD42017050335).

Reduction in Migraine and Headache Frequency and Intensity With Combined Antioxidant Prophylaxis (N‐acetylcysteine, Vitamin E, and Vitamin C): A Randomized Sham‐Controlled Pilot Study

“…There were also significant reductions in average monthly migraine episodes, headache pain scores, acute medication use and monthly migraine duration in the NEC treatment group. The results are equivalent to those reported in other migraine prophylaxis trials 4–9,56–64 . However, any conclusions regarding the role of antioxidants in migraine should be interpreted within the limitations of this pilot study design.…”

“…Reductions in the number of headache episodes, moderate or severe headaches, and migraine days by approximately 3 per month with NEC are clinically meaningful improvements and equivalent to the results of migraine prophylaxis trials with anti‐CGRP antibodies, 4–9,56 beta blockers, 57,58 topiramate, 59–62 botulinum toxin, 63,64 and nutraceuticals such as curcumin and coenzyme Q, 39,40 riboflavin, 66–68 and melatonin 69 . There were also decreases in all outcome measures in the sham treatment group consistent with the strong placebo effect reported in many migraine trials 70 .…”

A genome-wide cross-phenotype meta-analysis of the association of blood pressure with migraine

“…The relationship is further complicated by longitudinal studies suggesting that migraine may increase the risk of incident hypertension 12,13 , whereas BP has been found to be inversely related to onset of headache and migraine 14 . Regardless, BP-lowering medications notably provide prophylactic benefit for many migraineurs, and the choice of antihypertensive appears to be related to comorbidities, cost, availability, or side effect profile rather than the specific mechanism of BP-lowering 15,16 .…”

An Investigation into the Prevalence of Migraine and its Prophylactic Treatment Patterns in the Czech Republic

“…By prevalence approach, antiepileptics (topiramate) and beta blockers (metoprolol) were the most prescribed drugs, and the antiepileptics topiramate and pregabalin were mostly used by newly diagnosed patients. There is similar evidence supporting the use of beta blockers such as metoprolol [7,25], and antiepileptic drugs such as topiramate as preventive medication for migraine [7,26].…”