Summary of findings for the main comparison. SSRIs or SNRIs compared to placebo for migraine prevention in adults.
| SSRIs or SNRIs compared to placebo for migraine prophylaxis in adults | ||||||
| Patient or population: patients for whom migraine preventive interventions are indicated Intervention: SSRIs or SNRIs Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo | SSRIs or SNRIs | |||||
| Migraine frequency Number of attacks Follow‐up: 2 to 3 months | See comment | See comment | — | 113 (2 studies) | ⊕⊕⊝⊝ low1 | Studies not pooled, inconclusive data |
| Migraine intensity Score Follow‐up: 2 to 3 months | See comment | See comment | — | 113 (2 studies) | ⊕⊕⊝⊝ low1 | Studies not pooled, inconclusive data |
|
Migraine duration Hours Follow‐up: 2 to 3 months |
See comment | See comment | — | 60 (1 study) |
See comment | Data reported as median, no statistically significant difference |
|
Symptomatic/analgesic medication use for acute headache attacks Follow‐up: 2 to 3 months |
See comment | See comment | — | 113 (2 studies) | ⊕⊕⊝⊝ low1 | Studies not pooled, inconclusive data |
| Migraine index Follow‐up: mean 2 months | The mean migraine index ranged across control groups from 24 to 77.2 points | The mean migraine index in the intervention groups was 0.14 SD lower (0.57 lower to 0.3 higher) | — | 86 (3 studies) | ⊕⊝⊝⊝ very low2 | As a rule of thumb, 0.2 SD represents a small difference, 0.5 moderate and 0.8 large (Cohen 1988) |
| Quality of life | See comment | See comment | Not estimable | — | See comment | Not measured |
| Withdrawn (due to adverse events) | Study population | OR 1.95 (0.70 to 5.44) | 221 (5 studies) | ⊕⊝⊝⊝ very low2 | — | |
| 53 per 1000 | 99 per 1000 (38 to 234) | |||||
| *The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; SD: standard deviation; SNRI: serotonin‐norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Limitations in study design, imprecision (insufficient data).
2Limitations in study design, imprecision (insufficient data), indirectness (lack of generalisability).