Abstract
Background:
Migraine is a highly prevalent neurological disorder, with prevalence rates ranging from 9% to 18% worldwide. Current pharmacological prophylactic strategies for migraine have limited efficacy and acceptability, with relatively low response rates of 40%-50% and limited safety profiles. Eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) are considered to be promising therapeutic agents for migraine prophylaxis.
Objective:
The aim of this network meta-analysis (NMA) was to compare the efficacy and acceptability of various doses of EPA/DHA and other current FDA-approved or guideline-recommended prophylactic pharmacological interventions for migraine.
Methods:
Randomized controlled trials (RCTs) were eligible for inclusion if they enrolled participants with a diagnosis of either episodic or chronic migraine. All NMA procedures were conducted under the frequentist model. The primary outcomes assessed are (1) changes in migraine frequency and (2) acceptability (i.e., drop-out due to any reason). Secondary outcomes include response rates, changes in migraine severity, changes in the frequency of using rescue medications, and the frequency of any adverse events.
Results:
40 RCTs were included (N=6616; mean age= 35.0 years; 78.9% women). Our analysis show that supplementation with high-dose EPA/DHA yield the highest decrease in migraine frequency [standardized mean difference (SMD)=-1.36, 95% confidence intervals (95%CIs): -2.32 to -0.39 compared to placebo groups] and the largest decrease in migraine severity (SMD=-2.23, 95%CIs: -3.17 to -1.30 compared to placebo groups) for all studied interventions. Furthermore, supplementation with high-dosage EPA/DHA show the most favorable acceptability rates (odds ratio=1.00, 95%CIs: 0.06 to 17.41 compared to placebo groups) among all examined prophylactic treatments.
Conclusions:
This study provides compelling evidence that high-dose prophylactic EPA/DHA supplementation can be considered a first-choice treatment for migraine prophylaxis since this treatment displayed the highest efficacy and highest acceptability for all studied treatments.
Registry:
PROSPERO (CRD42022319577).
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