Pharmacologic treatment of migraine. Comparison of guidelines.
OBJECTIVE
To compare guidelines (not the primary studies) for pharmacologic treatment of migraine as to methods of guideline development; recommendations, particularly on triptans; and quality of supporting evidence (with emphasis on comparative studies of triptans versus ergot alkaloids and nonsteroidal anti-inflammatory drugs [NSAIDs]).


METHODS
We searched MEDLINE via PubMed for guidelines on migraine management published since 1990 in any language; in addition, we browsed the Internet for information.


METHODS
We found nine clinical guidelines on migraine; one guideline, not supported by references, was excluded.


RESULTS
Preference for triptans is not well founded and is largely based on comparisons with placebo. Too few studies compared new drugs with established ones (NSAIDs or dihydroergotamine). Guidelines that propose a hierarchy for selection of drugs are opinion-based rather than evidence-based.


CONCLUSIONS
The current lack of evidence from comparative studies seriously limits development of evidence-based clinical practice guidelines for pharmacologic treatment of migraine.
Dutch Institute for Effective Use of Medicine in Utrecht, The Netherlands.
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Schuurmans
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van Weel
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use*; D004879:Ergotamines / Q000627:therapeutic use; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use*; D018170:Sumatriptan / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D004879:Ergotamines; D017366:Serotonin Receptor Agonists; D018170:Sumatriptan