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Updated Canadian Headache Society Migraine Prevention Guideline with Systematic Review and Meta-analysis
Ioana Medrea1,2, Paul Cooper3, Marissa Langman3
1Division of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA.
Summary
This updated guideline offers new recommendations for migraine prevention, including chronic migraine, with a focus on novel anti-calcitonin gene-related peptide (CGRP) therapies and other treatments available in Canada.
Area of Science:
- Neurology
- Pharmacology
Background:
- The Canadian Headache Society's 2012 migraine prevention guideline required updating due to new therapeutic options.
- The previous guideline did not address the prevention of chronic migraine.
Purpose of the Study:
- To update the 2012 Canadian guideline for migraine prevention.
- To provide specific guidelines for the prevention of chronic migraine.
- To incorporate new therapies approved between 2018 and 2024.
Main Methods:
- Systematic review of new studies since the last guideline.
- Data extraction and meta-analyses where feasible.
- Modified Delphi recommendation process for treatment guidance.
- Expert consensus on clinical application of therapies.
Main Results:
- 16 therapies were evaluated based on 61 studies.
- Anti-calcitonin gene-related peptide (CGRP) agents offer new options for episodic and chronic migraine.
- Evidence for propranolol, topiramate, and onabotulinumtoxinA in chronic migraine was summarized.
- Topiramate and gabapentin recommendations were downgraded for episodic migraine.
- Memantine, levetiracetam, enalapril, and melatonin received weak recommendations for episodic migraine.
Conclusions:
- Updated recommendations for episodic and chronic migraine prevention are provided.
- Guidance on the clinical use of available migraine treatments in Canada is included.
