Bridging the gap between evidence and clinical practice for migraine headaches: a systematic review (2019-2024)

Migraine headache (MH) is a prevalent and complex neurological disorder affecting over one billion individuals worldwide, making it one of the leading causes of years lived with disability. Randomized controlled trials (RCTs) support evidence-based neurology, but whether recent trials provide practice-ready information remains unclear. This study aims to identify common shortcomings in design and reporting; highlight trial features that enhance value to practicing clinicians; and offer recommendations that improve the alignment between MH research and patient-centered care.

We systematically reviewed RCTs focused on acute or preventive MH interventions indexed in Embase and MEDLINE from January 1, 2019, to December 31, 2024, against a 13-item usefulness criteria that captures clinical utility and transparency. Published RCT search filters were adapted from Cochrane strategies, and the complete strategy is available on Open Science Framework (OSF). Trial characteristics and usefulness predictors were analyzed via descriptive statistics and linear regression models. Risk of bias assessment was not performed due to the unavailability of the planned tool. Our evaluation may be influenced by subjectivity in valuing certain clinical utility criteria.

Our systematic review of 169 MH RCTs reveals a field marked by slow yet measurable progress: while over half (50.9%) surpassed the midpoint on the usefulness scale, fewer than 2% met the threshold for high utility. Notably, patient-centeredness (98.8%) and context placement (66.9%) were commonly satisfied. However, other domains, particularly data availability (1.8%) and economic evaluation (0.6%), remain significantly underdeveloped. A Pearson's correlation analysis between clinical utility and transparency demonstrated a weakly positive trend (r = 0.23, p < 0.05); however, total usefulness varied, suggesting that policy guidelines have not invoked substantial design changes in MH research.

These findings highlight a persistent mismatch between the evidence clinicians need and the trials currently conducted. To bridge this gap, future MH RCTs could broaden eligibility, publish de-identified data and economic analyses, and reflect positive patient outcomes. Strengthening these domains may accelerate translation of research into reliable and equitable MH care for the more than one billion people affected worldwide.