PMID- 30699098
OWN - NLM
STAT- MEDLINE
DCOM- 20190626
LR  - 20210114
IS  - 1872-6623 (Electronic)
IS  - 0304-3959 (Linking)
VI  - 160
IP  - 4
DP  - 2019 Apr
TI  - Flunarizine as prophylaxis for episodic migraine: a systematic review with 
      meta-analysis.
PG  - 762-772
LID - 10.1097/j.pain.0000000000001456 [doi]
AB  - Based on few clinical trials, flunarizine is considered a first-line prophylactic 
      treatment for migraine in several guidelines. In this meta-analysis, we examined 
      the pooled evidence for its effectiveness, tolerability, and safety. Prospective 
      randomized controlled trials of flunarizine as a prophylaxis against migraine 
      were identified from a systematic literature search, and risk of bias was 
      assessed for all included studies. Reduction in mean attack frequency was 
      estimated by calculating the mean difference (MD), and a series of secondary 
      outcomes-including adverse events (AEs)-were also analyzed. The database search 
      yielded 879 unique records. Twenty-five studies were included in data synthesis. 
      We scored 31/175 risk of bias items as "high," with attrition as the most 
      frequent bias. A pooled analysis estimated that flunarizine reduces the headache 
      frequency by 0.4 attacks per 4 weeks compared with placebo (5 trials, 249 
      participants: MD -0.44; 95% confidence interval -0.61 to -0.26). Analysis also 
      revealed that the effectiveness of flunarizine prophylaxis is comparable with 
      that of propranolol (7 trials, 1151 participants, MD -0.08; 95% confidence 
      interval -0.34 to 0.18). Flunarizine also seems to be effective in children. The 
      most frequent AEs were sedation and weight increase. Meta-analyses were robust 
      and homogenous, although several of the included trials potentially suffered from 
      high risk of bias. Unfortunately, reporting of AEs was inconsistent and limited. 
      In conclusion, pooled analysis of data from partially outdated trials shows that 
      10-mg flunarizine per day is effective and well tolerated in treating episodic 
      migraine-supporting current guideline recommendations.
FAU - Stubberud, Anker
AU  - Stubberud A
AD  - Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of 
      Science and Technology, Trondheim, Norway.
FAU - Flaaen, Nikolai Melseth
AU  - Flaaen NM
AD  - Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of 
      Science and Technology, Trondheim, Norway.
FAU - McCrory, Douglas C
AU  - McCrory DC
AD  - Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, NC, 
      United States.
AD  - Department of Medicine, Duke University School of Medicine, Durham, NC, United 
      States.
AD  - Center for Health Services Research in Primary Care, Durham Veterans Affairs 
      Medical Center, Durham, NC, United States.
FAU - Pedersen, Sindre Andre
AU  - Pedersen SA
AD  - Library Section for Medicine and Health Sciences, NTNU University Library, NTNU 
      Norwegian University of Science and Technology, Trondheim, Norway.
FAU - Linde, Mattias
AU  - Linde M
AD  - Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of 
      Science and Technology, Trondheim, Norway.
AD  - Norwegian Advisory Unit on Headaches, St. Olavs Hospital, Trondheim, Norway.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - United States
TA  - Pain
JT  - Pain
JID - 7508686
RN  - 0 (Histamine H1 Antagonists)
RN  - R7PLA2DM0J (Flunarizine)
SB  - IM
MH  - Databases, Bibliographic
MH  - Flunarizine/*therapeutic use
MH  - Histamine H1 Antagonists/*therapeutic use
MH  - Humans
MH  - Migraine Disorders/*prevention & control
MH  - Randomized Controlled Trials as Topic
EDAT- 2019/01/31 06:00
MHDA- 2019/06/27 06:00
CRDT- 2019/01/31 06:00
PHST- 2019/01/31 06:00 [pubmed]
PHST- 2019/06/27 06:00 [medline]
PHST- 2019/01/31 06:00 [entrez]
AID - 00006396-201904000-00002 [pii]
AID - 10.1097/j.pain.0000000000001456 [doi]
PST - ppublish
SO  - Pain. 2019 Apr;160(4):762-772. doi: 10.1097/j.pain.0000000000001456.