PDF(Pubmed)
Abstract：
Migraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy.
To evaluate the benefits and harms associated with acute treatments for episodic migraine in adults.
Multiple databases from database inception to February 24, 2021.
Randomized clinical trials and systematic reviews that assessed effectiveness or harms of acute therapy for migraine attacks.
Independent reviewers selected studies and extracted data. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction or by using a fixed-effect model based on the Mantel-Haenszel method if the number of studies was small.
The main outcomes included pain freedom, pain relief, sustained pain freedom, sustained pain relief, and adverse events. The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews.
Evidence on triptans and nonsteroidal anti-inflammatory drugs was summarized from 15 systematic reviews. For other interventions, 115 randomized clinical trials with 28 803 patients were included. Compared with placebo, triptans and nonsteroidal anti-inflammatory drugs used individually were significantly associated with reduced pain at 2 hours and 1 day (moderate to high SOE) and increased risk of mild and transient adverse events. Compared with placebo, calcitonin gene-related peptide receptor antagonists (low to high SOE), lasmiditan (5-HT1F receptor agonist; high SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), acetaminophen (moderate SOE), antiemetics (low SOE), butorphanol (low SOE), and tramadol in combination with acetaminophen (low SOE) were significantly associated with pain reduction and increase in mild adverse events. The findings for opioids were based on low or insufficient SOE. Several nonpharmacologic treatments were significantly associated with improved pain, including remote electrical neuromodulation (moderate SOE), transcranial magnetic stimulation (low SOE), external trigeminal nerve stimulation (low SOE), and noninvasive vagus nerve stimulation (moderate SOE). No significant difference in adverse events was found between nonpharmacologic treatments and sham.
There are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments was associated with improved pain and function. The evidence for many other interventions, including opioids, was limited.
To evaluate the benefits and harms associated with acute treatments for episodic migraine in adults.
Multiple databases from database inception to February 24, 2021.
Randomized clinical trials and systematic reviews that assessed effectiveness or harms of acute therapy for migraine attacks.
Independent reviewers selected studies and extracted data. Meta-analysis was performed with the DerSimonian-Laird random-effects model with Hartung-Knapp-Sidik-Jonkman variance correction or by using a fixed-effect model based on the Mantel-Haenszel method if the number of studies was small.
The main outcomes included pain freedom, pain relief, sustained pain freedom, sustained pain relief, and adverse events. The strength of evidence (SOE) was graded with the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews.
Evidence on triptans and nonsteroidal anti-inflammatory drugs was summarized from 15 systematic reviews. For other interventions, 115 randomized clinical trials with 28 803 patients were included. Compared with placebo, triptans and nonsteroidal anti-inflammatory drugs used individually were significantly associated with reduced pain at 2 hours and 1 day (moderate to high SOE) and increased risk of mild and transient adverse events. Compared with placebo, calcitonin gene-related peptide receptor antagonists (low to high SOE), lasmiditan (5-HT1F receptor agonist; high SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), acetaminophen (moderate SOE), antiemetics (low SOE), butorphanol (low SOE), and tramadol in combination with acetaminophen (low SOE) were significantly associated with pain reduction and increase in mild adverse events. The findings for opioids were based on low or insufficient SOE. Several nonpharmacologic treatments were significantly associated with improved pain, including remote electrical neuromodulation (moderate SOE), transcranial magnetic stimulation (low SOE), external trigeminal nerve stimulation (low SOE), and noninvasive vagus nerve stimulation (moderate SOE). No significant difference in adverse events was found between nonpharmacologic treatments and sham.
There are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments was associated with improved pain and function. The evidence for many other interventions, including opioids, was limited.
摘要：
偏头痛是常见的，可能与显著的发病率有关，和几种治疗方案存在的急性治疗。
评估成人发作性偏头痛急性治疗的益处和危害。
从数据库开始到2021年2月24日的多个数据库。
评估偏头痛急性治疗的有效性或危害的随机临床试验和系统评价。
独立审稿人选择研究并提取数据。如果研究数量较少，则使用DerSimonian-Laird随机效应模型和Hartung-Knapp-Sidik-Jonkman方差校正进行荟萃分析，或使用基于Mantel-Haenszel方法的固定效应模型进行荟萃分析。
主要结果包括疼痛自由，疼痛缓解,持续的疼痛自由，持续的疼痛缓解，和不良事件。证据强度（SOE）根据《医疗保健研究机构和质量方法有效性和比较有效性评估指南》进行分级。
从15篇系统综述中总结了关于曲坦类药物和非甾体类抗炎药的证据。对于其他干预措施，纳入115项随机临床试验，28803例患者。与安慰剂相比，曲坦类药物和非甾体类抗炎药单独使用与2小时和1天疼痛减轻(中度至高度SOE)和轻度和短暂性不良事件风险增加显著相关.与安慰剂相比，降钙素基因相关肽受体拮抗剂（低到高SOE），lasmiditan（5-HT1F受体激动剂；高SOE），二氢麦角胺（中等至高SOE），麦角胺加咖啡因（中度SOE），对乙酰氨基酚（中度SOE），止吐药（低SOE），布托啡诺（低SOE），曲马多联合对乙酰氨基酚(低SOE)与疼痛减轻和轻度不良事件增加显著相关.阿片类药物的发现是基于SOE低或不足。几种非药物治疗与疼痛改善显着相关，包括远程电神经调节（中度SOE），经颅磁刺激（低SOE），外部三叉神经刺激（低SOE），和非侵入性迷走神经刺激（中度SOE）。在非药物治疗和假手术之间，不良事件没有显着差异。
偏头痛有几种急性治疗方法，不同强度的支持证据。使用Triptans,非甾体抗炎药，对乙酰氨基酚,二氢麦角胺，降钙素基因相关肽拮抗剂，Lasmiditan,一些非药物治疗与疼痛和功能改善相关。许多其他干预措施的证据，包括阿片类药物,是有限的。
评估成人发作性偏头痛急性治疗的益处和危害。
从数据库开始到2021年2月24日的多个数据库。
评估偏头痛急性治疗的有效性或危害的随机临床试验和系统评价。
独立审稿人选择研究并提取数据。如果研究数量较少，则使用DerSimonian-Laird随机效应模型和Hartung-Knapp-Sidik-Jonkman方差校正进行荟萃分析，或使用基于Mantel-Haenszel方法的固定效应模型进行荟萃分析。
主要结果包括疼痛自由，疼痛缓解,持续的疼痛自由，持续的疼痛缓解，和不良事件。证据强度（SOE）根据《医疗保健研究机构和质量方法有效性和比较有效性评估指南》进行分级。
从15篇系统综述中总结了关于曲坦类药物和非甾体类抗炎药的证据。对于其他干预措施，纳入115项随机临床试验，28803例患者。与安慰剂相比，曲坦类药物和非甾体类抗炎药单独使用与2小时和1天疼痛减轻(中度至高度SOE)和轻度和短暂性不良事件风险增加显著相关.与安慰剂相比，降钙素基因相关肽受体拮抗剂（低到高SOE），lasmiditan（5-HT1F受体激动剂；高SOE），二氢麦角胺（中等至高SOE），麦角胺加咖啡因（中度SOE），对乙酰氨基酚（中度SOE），止吐药（低SOE），布托啡诺（低SOE），曲马多联合对乙酰氨基酚(低SOE)与疼痛减轻和轻度不良事件增加显著相关.阿片类药物的发现是基于SOE低或不足。几种非药物治疗与疼痛改善显着相关，包括远程电神经调节（中度SOE），经颅磁刺激（低SOE），外部三叉神经刺激（低SOE），和非侵入性迷走神经刺激（中度SOE）。在非药物治疗和假手术之间，不良事件没有显着差异。
偏头痛有几种急性治疗方法，不同强度的支持证据。使用Triptans,非甾体抗炎药，对乙酰氨基酚,二氢麦角胺，降钙素基因相关肽拮抗剂，Lasmiditan,一些非药物治疗与疼痛和功能改善相关。许多其他干预措施的证据，包括阿片类药物,是有限的。
