Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis
Headaches 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. Cochrane Register of Controlled Trials; MEDLINE; EMBASE; ISI Web of Science, clinical trial registries, CNKI, Wanfang and CQVIP were se...
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| Published in | PloS one Vol. 14; no. 3; p. e0212785 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
20.03.2019
Public Library of Science (PLoS) |
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| Online Access | Get full text |
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| Abstract | Headaches 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.
Cochrane 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.
This 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.
There 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.
Prospero (ID: CRD42017050335). |
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| AbstractList | Headaches 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. Cochrane 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. There 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. Background Headaches 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. Methods Cochrane 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 synthesis This 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. Conclusions There 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. Registration Prospero (ID: CRD42017050335). 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). Background Headaches 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. Methods Cochrane 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 synthesis This 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. Conclusions There 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. Registration Prospero (ID: CRD42017050335). Headaches 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. Cochrane 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. This 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. There 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. Prospero (ID: CRD42017050335). |
| Audience | Academic |
| Author | Kuwatsuka, Yachiyo Nickoloff, Sarah Zhang, Zhi-Jiang Jackson, Wilkins Jackson, Jeffrey L Hayashino, Yasuaki Kuriyama, Akira Storch, Derek |
| AuthorAffiliation | 5 Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China Keele University, UNITED KINGDOM 2 Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan 1 Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI, United States of America 6 Department of Endocrinology, Tenri Hospital, Nara, Japan 4 Department of Biology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America 3 Department of Medicine, Nagoya University Hospital, Nagoya, Japan |
| AuthorAffiliation_xml | – name: 2 Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan – name: 4 Department of Biology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America – name: 6 Department of Endocrinology, Tenri Hospital, Nara, Japan – name: 1 Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI, United States of America – name: 5 Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China – name: Keele University, UNITED KINGDOM – name: 3 Department of Medicine, Nagoya University Hospital, Nagoya, Japan |
| Author_xml | – sequence: 1 givenname: Jeffrey L orcidid: 0000-0002-9820-5834 surname: Jackson fullname: Jackson, Jeffrey L organization: Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI, United States of America – sequence: 2 givenname: Akira surname: Kuriyama fullname: Kuriyama, Akira organization: Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan – sequence: 3 givenname: Yachiyo surname: Kuwatsuka fullname: Kuwatsuka, Yachiyo organization: Department of Medicine, Nagoya University Hospital, Nagoya, Japan – sequence: 4 givenname: Sarah surname: Nickoloff fullname: Nickoloff, Sarah organization: Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI, United States of America – sequence: 5 givenname: Derek surname: Storch fullname: Storch, Derek organization: Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI, United States of America – sequence: 6 givenname: Wilkins surname: Jackson fullname: Jackson, Wilkins organization: Department of Biology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States of America – sequence: 7 givenname: Zhi-Jiang surname: Zhang fullname: Zhang, Zhi-Jiang organization: Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China – sequence: 8 givenname: Yasuaki surname: Hayashino fullname: Hayashino, Yasuaki organization: Department of Endocrinology, Tenri Hospital, Nara, Japan |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30893319$$D View this record in MEDLINE/PubMed |
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| Snippet | Headaches 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.... Background Headaches are a common source of pain and suffering. The study's purpose was to assess beta-blockers efficacy in preventing migraine and... Background Headaches are a common source of pain and suffering. The study’s purpose was to assess beta-blockers efficacy in preventing migraine and... 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... 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... Background Headaches are a common source of pain and suffering. The study’s purpose was to assess beta-blockers efficacy in preventing migraine and... |
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| SubjectTerms | Adrenergic beta-antagonists Adrenergic beta-Antagonists - therapeutic use Adult Adults Analysis Antidepressants Beta blockers Clinical trials Clinical Trials as Topic Control methods Dosage and administration Error analysis Female Headache Headaches Hospitals Humans Male Medicine Medicine and Health Sciences Meta-analysis Migraine Migraine Disorders - drug therapy Migraine Disorders - physiopathology Network analysis Pain Physical Sciences Prevention Propranolol Propranolol - therapeutic use Randomization Research and Analysis Methods Sequential analysis Serotonin Studies Systematic review Tension Tension headache Tension-Type Headache - drug therapy Tension-Type Headache - physiopathology Topiramate Topiramate - therapeutic use Treatment outcome Valproic acid Valproic Acid - therapeutic use |
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| Title | Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis |
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