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Targeted Review: Medications for Acute Migraine Treatment

Published online by Cambridge University Press:  01 July 2015

Irene Worthington ,
Tamara Pringsheim ,
Marek J. Gawel ,
Jonathan Gladstone ,
Paul Cooper ,
Esma Dilli ,
Michel Aube ,
Elizabeth Leroux ,
Werner J. Becker  and
on behalf of the Canadian Headache Society Acute Migraine Treatment Guideline Development Group
Irene Worthington
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario
Tamara Pringsheim
Affiliation:
University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta
Marek J. Gawel
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario Rouge Valley Health System – Centenary, Toronto, Ontario Women's College Hospital, Toronto, Ontario, Canada
Jonathan Gladstone
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario Gladstone Headache Clinic, Toronto, Ontario
Paul Cooper
Affiliation:
University of Western Ontario, London, Ontario
Esma Dilli
Affiliation:
University of British Columbia, Vancouver, British Columbia
Michel Aube
Affiliation:
McGill University, Montreal, Quebec
Elizabeth Leroux
Affiliation:
University of Montreal, Montreal, Quebec
Werner J. Becker*
Affiliation:
University of Calgary and the Hotchkiss Brain Institute, Calgary, Alberta
*
Division of Neurology, 12th Floor, Foothills Hospital, 1403 29th St NW, Calgary, Alberta, T2N 2T9, Canada
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Abstract:

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Objective:

To assess the evidence base for drugs used for acute treatment of episodic migraine (headache on < 14 days a month) in Canada.

Methods:

A detailed search strategy was employed to find relevant published clinical trials of drugs used in Canada for the acute treatment of migraine in adults. Primarily meta-analyses and systematic reviews were included. Where these were not available for a drug or were out of date, individual clinical trial reports were utilized. Only double-blind randomized clinical trials with placebo or active drug controls were included in the analysis. Recommendations and levels of evidence were graded according to the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group, using a consensus group.

Results:

Eighteen acute migraine medications and two adjunctive medications were evaluated. Twelve acute medications received a strong recommendation with supporting high quality evidence for use in acute migraine therapy (almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, ASA, ibuprofen, naproxen sodium, diclofenac potassium, and acetaminophen). Four acute medications received a weak recommendation for use with low or moderate quality evidence (dihydroergotamine, ergotamine, codeine-containing combination analgesics, and tramadol-containing combination analgesics). Three of these medications were NOT recommended for routine use (ergotamine, and codeine- and tramadol-containing medications), and strong recommendations were made to avoid use of butorphanol and butalbital-containing medications. Both metoclopramide and domperidone received a strong recommendation for use with acute migraine attack medications where necessary.

Conclusion:

Our targeted review formulated recommendations for the available acute medications for migraine treatment according to the GRADE method. This should be helpful for practitioners who prescribe medications for acute migraine treatment.

Type
SECTION II
Information
Canadian Journal of Neurological Sciences , Volume 40 , Issue S3 , September 2013 , pp. S10 - S32
Copyright
Copyright © The Canadian Journal of Neurological 2014

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