Comparative Efficacy of Venlafaxine and Other Medications in Migraine: A Meta-Analysis with Trial Sequential Analysis

This meta-analysis with trial sequential analysis (TSA) evaluated the efficacy of venlafaxine in migraine prevention through database searches from inception to 1st November 2024. A total of eight studies involving 582 patients were included. Results demonstrated venlafaxine's superior overall efficacy (OR = 18.71, p = 0.0008) and significant reductions in multiple outcomes, including Visual Analogue Scale Score (MD = -0.83, p = 0.03), migraine days (MD = -1.59, p = 0.02), Dizziness Handicap Inventory (DHI)-total (MD = -5.16, p = 0.01), DHI-physical (MD = -1.73, p = 0.02), DHI-emotional (MD = -2.04, p = 0.02), vertigo severity scores (MD = -1.18, p = 0.0007), and analgesic use (MD = -3.32, p <0.001). No differences were observed in withdrawals due to adverse reactions and any other reasons, including DHI-functional change, duration, frequency change in the Venlafaxine group VLF versus the Other medicines group. TSA revealed insufficient evidence for dizziness improvement (DHI-total: required information size [RIS] = 614 versus currently available size = 242), requiring 372 additional patients to confirm stability and mitigate false positives. While venlafaxine showed advantages over most comparators in efficacy and safety measures, these findings require further validation through larger-scale studies. Key Words: Migraine, Venlafaxine, Meta-analysis, Trial sequential analysis, Efficacy.