Two different doses of Amitriptyline ER in the prophylaxis of migraine: long‐term results and predictive factors

Lampl, Christian; Huber, Gerald; Adl, J.; Luthringshausen, G.; Franz, G.; Marecek, S.; Weber, Joerg R.; Baumhackl, Ulf; Mueller, Thomas

doi:10.1111/j.1468-1331.2009.02631.x

Cited by 22 publications

(23 citation statements)

References 15 publications

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“…Amitriptyline was better than placebo in reducing monthly migraine, but only in patients with depression or baseline frequent and severe migraine 93 (OR, 2.4; 95 % CI, 1.45-3.8 for every additional day of migraine at baseline). 94 No trials directly compared drug effects in patients with and without aura. Several post hoc subgroup analyses of topiramate versus placebo provided inconsistent efficacy evidence regarding aura.…”

Section: Drug Effect Modification By Select Patient Characteristicsmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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ELIGIBILITY CRITERIA: English-language randomized controlled trials (RCTs) of preventive drugs compared to placebo or active treatments examining rates of ≥50 % reduction in monthly migraine frequency or improvement in quality of life. STUDY APPRAISAL AND SYNTHESIS METHODS:We assessed risk of bias and strength of evidence and conducted random effects meta-analyses of absolute risk differences and Bayesian network meta-analysis. RESULTS: Of 5,244 retrieved references, 215 publications of RCTs provided mostly low-strength evidence because of the risk of bias and imprecision. RCTs examined 59 drugs from 14 drug classes. All approved drugs, including topiramate (9 RCTs), divalproex (3 RCTs), timolol (3 RCTs), and propranolol (4 RCTs); offlabel beta blockers metoprolol (4 RCTs), atenolol (1 RCT), nadolol (1 RCT), and acebutolol (1 RCT); angiotensin-converting enzyme inhibitors captopril (1 RCT) and lisinopril (1 RCT); and angiotensin II receptor blocker candesartan (1 RCT), outperformed placebo in reducing monthly migraine frequency by ≥50 % in 200-400 patients per 1,000 treated. Adverse effects leading to treatment discontinuation (68 RCTs) were greater with topiramate, off-label antiepileptics, and antidepressants than with placebo. Limited direct evidence as well as frequentist and exploratory network Bayesian meta-analysis showed no statistically significant differences in benefits between approved drugs. Off-label angiotensin-inhibiting drugs and beta-blockers were most effective and tolerable for episodic migraine prevention. LIMITATIONS:We did not quantify reporting bias or contact principal investigators regarding unpublished trials. CONCLUSIONS: Approved drugs prevented episodic migraine frequency by ≥50 % with no statistically significant difference between them. Exploratory network meta-analysis suggested that off-label angiotensin-inhibiting drugs and beta-blockers had favorable benefit-to-harm ratios. Evidence is lacking for longterm effects of drug treatments (i.e., trials of more than 3 months duration), especially for quality of life.KEY WORDS: migraine; evidence based medicine; adverse drug effects.

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Section: Drug Effect Modification By Select Patient Characteristicsmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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“…26 Studies were conducted in Germany, [21][22][23] Austria, 24 Belgium, 26 the Netherlands, 27 and Brazil. 25 Dosages varied by individual patient but were within the range of approved FDA-labeled dose for migraine prophylaxis, where applicable.…”

Section: Observational Studies: Persistencementioning

confidence: 99%

Systematic Review of Migraine Prophylaxis Adherence and Persistence

Hepp

Bloudek²,

Varon³

2014

JMCP

268

269

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“…The above studies represent the placebo‐controlled studies of amitriptyline in treatment of headache including migraine. Most studies subsequent to 1987 have been primarily comparison studies of amitriptyline vs another potential prophylactic antimigraine drug without a placebo comparison 18‐25 . These studies have generally shown that amitriptyline is comparable with or better than other known or potential prophylactic antimigraine agents.…”

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confidence: 99%

Amitriptyline in the Prophylactic Treatment of Migraine and Chronic Daily Headache

Couch

2010

Headache

123

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In this study, using headache frequency as the primary metric, for the entire group, amitriptyline was superior to placebo in migraine prophylaxis at 8 weeks but, because of a robust placebo response, not at subsequent time points. For the subgroup with CDH, amitriptyline was statistically significantly superior to placebo at 8 weeks and 16 weeks with a similar but nonsignificant trend at 12 and 20 weeks. Compared with placebo amitriptyline is effective in CDH. Amitriptyline was also significantly effective in IM compared intragroup to its own baseline; however, placebo was equally effective in the same analysis. The reason for the robust placebo response in the IM group is not clear, but has been occasionally reported.

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Two different doses of Amitriptyline ER in the prophylaxis of migraine: long‐term results and predictive factors

Abstract: The prophylactic effect of amitriptyline seen in our study was rather weak and did not differ between the two treatment groups. The results of this 6-month, prospective, open-label clinical observation are therefore not encouraging.

Cited by 22 publications

References 15 publications

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Systematic Review of Migraine Prophylaxis Adherence and Persistence

Amitriptyline in the Prophylactic Treatment of Migraine and Chronic Daily Headache

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