Cochrane systematic review and meta-analysis of botulinum toxin for the prevention of migraine.
BMJ Open
; 9(7): e027953, 2019 07 16.
Article
em En
| MEDLINE
| ID: mdl-31315864
ABSTRACT
OBJECTIVES:
To assess the effects of botulinum toxin for prevention of migraine in adults.DESIGN:
Systematic review and meta-analysis. DATA SOURCES CENTRAL, MEDLINE, Embase and trial registries. ELIGIBILITY CRITERIA We included randomised controlled trials (RCTs) of botulinum toxin compared with placebo, active treatment or clinically relevant different dose for adults with chronic or episodic migraine, with or without the additional diagnosis of medication overuse headache. DATA EXTRACTION ANDSYNTHESIS:
Cochrane methods were used to review double-blind RCTs. Twelve week post-treatment time-point data was analysed.RESULTS:
Twenty-eight trials (n=4190) were included. Trial quality was mixed. Botulinum toxin treatment resulted in reduced frequency of -2.0 migraine days/month (95% CI -2.8 to -1.1, n=1384) in chronic migraineurs compared with placebo. An improvement was seen in migraine severity, measured on a numerical rating scale 0 to 10 with 10 being maximal pain, of -2.70 cm (95% CI -3.31 to -2.09, n=75) and -4.9 cm (95% CI -6.56 to -3.24, n=32) for chronic and episodic migraine respectively. Botulinum toxin had a relative risk of treatment related adverse events twice that of placebo, but a reduced risk compared with active comparators (relative risk 0.76, 95% CI 0.59 to 0.98) and a low withdrawal rate (3%). Although individual trials reported non-inferiority to oral treatments, insufficient data were available for meta-analysis of effectiveness outcomes.CONCLUSIONS:
In chronic migraine, botulinum toxin reduces migraine frequency by 2 days/month and has a favourable safety profile. Inclusion of medication overuse headache does not preclude its effectiveness. Evidence to support or refute efficacy in episodic migraine was not identified.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Toxinas Botulínicas Tipo A
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Transtornos de Enxaqueca
Tipo de estudo:
Clinical_trials
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Etiology_studies
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Prognostic_studies
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Systematic_reviews
Limite:
Adult
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Humans
Idioma:
En
Revista:
BMJ Open
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Reino Unido