Pharmacologic treatment of migraine. Comparison of guidelines.

Abstract

OBJECTIVE: To compare guidelines (not the primary studies) for pharmacologic treatment of migraine as to methods of guideline development; recommendations, particularly on triptans; and quality of supporting evidence (with emphasis on comparative studies of triptans versus ergot alkaloids and nonsteroidal anti-inflammatory drugs [NSAIDs]). DATA SOURCES: We searched MEDLINE via PubMed for guidelines on migraine management published since 1990 in any language; in addition, we browsed the Internet for information. STUDY SELECTION: We found nine clinical guidelines on migraine; one guideline, not supported by references, was excluded. SYNTHESIS: Preference for triptans is not well founded and is largely based on comparisons with placebo. Too few studies compared new drugs with established ones (NSAIDs or dihydroergotamine). Guidelines that propose a hierarchy for selection of drugs are opinion-based rather than evidence-based. CONCLUSION: The current lack of evidence from comparative studies seriously limits development of evidence-based clinical practice guidelines for pharmacologic treatment of migraine.