Efficacy of β-Blockers in Migraine

Tfelt‐Hansen, Peer

doi:10.1177/03331024860060s502

Cited by 44 publications

(12 citation statements)

References 10 publications

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“…Metoprolol was superior to placebo or aspirin in three RCTs using the recommended 200 mg of metoprolol (27)(28)(29) and somewhat better than placebo in one RCT using the dose of 100 mg metoprolol (26,30). In one comparative RCT metoprolol was comparable to propranolol (31), although with wide 95% confidence intervals (CIs) (32). Propranolol, grade A [1], was superior to placebo in 10 RCTs and comparable to placebo in two RCTs (26) and remains the standard first-line drug for migraine prophylaxis.…”

Section: Prophylactic Migraine Drugsmentioning

confidence: 99%

A Review of Evidence-Based Medicine and Meta-Analytic Reviews in Migraine

Tfelt‐Hansen

2006

Cephalalgia

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The following systematic reviews and meta-analyses are presented and the results discussed: the evidence-based American guidelines, five systematic reviews on naratriptan, rizatriptan, eletriptan, sumatriptan and propranolol; a meta-analysis of sumatriptan, a meta-analysis of acute migraine therapy, a meta-analysis of triptans available in Canada and a large meta-analysis of oral triptans. The systematic reviews of several randomized trials of one drug overcome random effects in estimating treatment effect of the reviewed drug. The results from the large meta-analysis of several drugs are compared with head-to-head comparative trials. Results are generally the same in the meta-analysis and in the comparative trials, with some exceptions. Head-to-head comparisons should remain the 'gold standard' and meta-analyses are a useful supplement in cases when comparative trials are relatively small and when no comparative trials exist.

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Section: Prophylactic Migraine Drugsmentioning

confidence: 99%

A Review of Evidence-Based Medicine and Meta-Analytic Reviews in Migraine

Tfelt‐Hansen

2006

Cephalalgia

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“…3 Systemic propranolol and timolol have been shown to have equal efficacy as prophylactic agents. 4 The most likely mechanism by which beta-blockers act is through stabilization of the intrasynaptic serotonin-level in the serotonergic neurons of the brainstem. 5 Betablockers without intrinsic sympathomimetic activity (ISA) appear to be more effective than those with ISA.…”

Section: Commentmentioning

confidence: 99%

Topical timolol prevented migraine attacks

Bhagey

James

2004

Eye

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“…Randomised clinical trials provide objectives and systematic data on drug efficacy and safety, but they are often inadequate to guide the therapeutic choices in the "real world" outside the aseptic and ideal setting where they are carried out [11,12].…”

Section: Indication For Migraine Prophylaxis: What Should Be Achieved?mentioning

confidence: 99%

Clinical considerations preliminary to application of the Italian Society for the Study of Headache's guidelines regarding migraine prophylactic treatment

Sternieri¹,

Ferrari²,

Cicero³

2003

J Headache Pain

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IntroductionThis paper provides some clinical suggestions regarding the prescription of prophylactic headache treatment. The paper is directed to primary care physicians and to algologists who do not currently manage headache, and is based on the scientific evidence as summarized in the clinical guidelines elaborated by the Italian Society for the Study of Headache [1,2]. Indication for migraine prophylaxis: what should be achieved?The main goals of prophylactic treatment for migraine are to decrease headache attack frequency, length and intensity, to improve the efficacy of symptomatic drugs, to prevent the frequent intake of analgesic and specific migraine drugs, and to prevent the episodic headache from turning into chronic headache [2, 3]. Therefore, clinical evaluation of the patient, regarding the frequency, length and intensity of their headache attacks, is preliminary to the evaluation of treatment efficacy. In randomised clinical trials, a good answer to prophylactic treatment is evaluated as a 50% responder rate in 50% of the treated subjects [4,5].In everyday clinical practice, we often observe that in the vast majority of patients migraine does not have a constant trend and its time-related evolution depends on trigger factors often contingent and not foreseeable in the single subject. Only an adequately compiled headache diary concerning the previous months can reveal eventual pain cycles and help in deciding the preventive treatment start time and length [6]. If this record is not available, we believe that there is a risk of prescribing an ineffective drug too long or, quite the opposite, of discontinuing the treatment before the time necessary to observe the desired response to a potentially effective drug.Adequate therapeutic choices are not easy, even when specific guidelines are available. First of all, it is necessary to decide if, when and how to begin a prophylactic treatment, but on this point there are no absolute indications [2]. Abstract The main goals of prophylactic treatment for migraine are to decrease headache attack frequency, length and intensity, to improve the efficacy of symptomatic drugs, to reduce their need, and to prevent pain chronicization. Therefore, the choice of a prophylactic drug and the modality of treatment is not easy and often not adequately supported by literature data nor by current national and international guidelines. Moreover, the response of the migraine patient to treatment is often unforeseeable. The aim of this short review is to provide some practical suggestions to the physician regarding how to decide when to begin a migraine prophylactic treatment and how to apply the specific guidelines of the Italian Society for the Study of Headache.

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Efficacy of β-Blockers in Migraine

Cited by 44 publications

References 10 publications

A Review of Evidence-Based Medicine and Meta-Analytic Reviews in Migraine

A Review of Evidence-Based Medicine and Meta-Analytic Reviews in Migraine

Topical timolol prevented migraine attacks

Clinical considerations preliminary to application of the Italian Society for the Study of Headache's guidelines regarding migraine prophylactic treatment

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