A Comparative Systematic Review and Meta-analysis of Amitriptyline with Propranolol and Flunarizine for the Prophylaxis of Migraine Headache

Abstract

Objective: To assess the efficacy and safety of amitriptyline as a prophylactic treatment of migraine in comparison with propranolol and flunarizine.

Materials and methods: PubMed, Google Scholar, Cochrane Database of Clinical Trials, and ClinicalTrials.gov were searched along with gray literature, including internet search. Randomized clinical trials (RCTs), prospective and retrospective studies which included migraine patients were included. Screening and extraction of data were conducted, and the quality of randomized studies was evaluated using the Cochrane Risk of Bias tool. RevMan Web was employed for statistical analysis.

Results: About nine studies (n = 874), including seven randomized and two nonrandomized studies, were deemed suitable for data synthesis and analysis. As compared to propranolol, amitriptyline administration significantly lowered the monthly frequency, duration, and severity score of migraines. No significant differences were noted between amitriptyline and flunarizine groups for monthly migraine frequency and migraine severity. Additionally, there were no significant differences in the incidence of adverse reactions following amitriptyline administration when compared with propranolol and flunarizine.

Conclusion: Low-dose amitriptyline is a potent prophylactic treatment option for migraine with respect to frequency, duration, as well as severity of migraine episodes. Its efficacy profile is superior to placebo as well as propranolol and comparable to flunarizine, whereas safety profile is comparable to both propranolol and flunarizine.