降压药物对预防阵发性偏头痛的影响：系统评价和荟萃分析。

The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis.

机构信息

The George Institute for Global Health, , University of New South Wales, Sydney, Australia.

Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.

出版信息

Cephalalgia. 2023 Jun;43(6):3331024231183166. doi: 10.1177/03331024231183166.

DOI:10.1177/03331024231183166

PMID:37350141

Abstract

BACKGROUND

Currently, only a few specific blood pressure-lowering medications are recommended for migraine prevention. Whether benefits extend to other classes or drugs is uncertain.

METHODS

Embase, MEDLINE, and the Cochrane Central Registry of Controlled Trials were searched for randomized control trials on the effect of blood pressure-lowering medications compared with placebo in participants with episodic migraine. Data were collected on four outcomes - monthly headache or migraine days, and monthly headache or migraine attacks, with a standardised mean difference calculated for overall. Random effect meta-analysis was performed.

RESULTS

In total, 50 trials (70% of which were crossover) were included, comprising 60 comparisons. Overall mean age was 39 years, and 79% were female. Monthly headache days were fewer in all classes compared to placebo, and this was statistically significant for all but one class: alpha-blockers -0.7 (95% CI: -1.2, -0.1), angiotensin-converting enzyme inhibitors -1.3 (95% CI: -2.9, 0.2), angiotensin II receptor blockers -0.9 (-1.6, -0.1), beta-blocker -0.4 (-0.8, -0.0) and calcium channel blockers -1.8 (-3.4, -0.2). Standardised mean difference was significantly reduced for all drug classes and was separately significant for numerous specific drugs: clonidine, candesartan, atenolol, bisoprolol, metoprolol, propranolol, timolol, nicardipine and verapamil.

CONCLUSION

Among people with episodic migraine, a broader number of blood pressure-lowering medication classes and drugs reduce headache frequency than those currently included in treatment guidelines. The study was registered at PROSPERO (CRD42017079176).

摘要

背景

目前，仅有少数特定的降压药物被推荐用于偏头痛预防。其他类别或药物的益处是否存在尚不确定。

方法

检索 Embase、MEDLINE 和 Cochrane 对照试验中心注册库，以寻找比较降压药物与安慰剂对发作性偏头痛患者影响的随机对照试验。收集了四项结局指标的信息，即每月头痛或偏头痛天数和每月头痛或偏头痛发作次数，总体采用标准化均数差值进行计算。进行随机效应荟萃分析。

结果

共纳入 50 项试验（其中 70%为交叉试验），包含 60 项比较。总体平均年龄为 39 岁，79%为女性。与安慰剂相比，所有类别药物的每月头痛天数均减少，除了一种类别（α受体阻滞剂）外，其他均具有统计学意义：α受体阻滞剂 -0.7（95%置信区间：-1.2，-0.1），血管紧张素转换酶抑制剂 -1.3（95%置信区间：-2.9，0.2），血管紧张素Ⅱ受体阻滞剂 -0.9（-1.6，-0.1），β受体阻滞剂 -0.4（-0.8，-0.0）和钙通道阻滞剂 -1.8（-3.4，-0.2）。所有类别的标准化均数差值均显著降低，许多特定药物也具有显著差异：可乐定、坎地沙坦、阿替洛尔、比索洛尔、美托洛尔、普萘洛尔、噻吗洛尔、尼卡地平、维拉帕米。