Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society.
Level 1 - systematic review of randomized trials
Systematic review and evidence-based practice guideline assessing randomized and controlled clinical trials
PubMed 22529203 · doi:10.1212/WNL.0b013e3182535d0c
What was done
The Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society conducted a systematic review to update clinical guidelines on NSAIDs and complementary treatments for episodic migraine prevention in adults. The authors searched literature from June 1999 to May 2009. From 284 screened abstracts, 49 Class I or Class II studies on migraine prevention were identified, of which 15 examined NSAIDs, nontraditional, or complementary therapies.
What was found
The abstract reports evidence-based recommendation levels rather than pooled numeric effect sizes: - Level A (effective): Petasites (butterbur) reduces migraine attack frequency and severity. - Level B (probably effective): Fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, MIG-99 (feverfew), magnesium, riboflavin, and subcutaneous histamine. - Level C (possibly effective): Cyproheptadine, Co-Q10, estrogen, mefenamic acid, and flurbiprofen. - Inadequate/conflicting data: Aspirin, indomethacin, omega-3, and hyperbaric oxygen. - Level B (probably ineffective): Montelukast.
Why it matters
This guideline clarifies which over-the-counter NSAIDs, nutraceuticals, and complementary interventions have rigorous clinical trial evidence for episodic migraine prophylaxis, guiding non-traditional treatment choices.
Limits
The abstract provides categorical recommendation grades rather than quantitative effect sizes, absolute risk reductions, or safety data. The search was limited to a 10-year window (1999–2009). The total number of enrolled participants across the 15 included studies is not reported in the abstract.
Cited by
- supports Pyrrolizidine alkaloid-free butterbur herb provides significant relief for migraines.