{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:35:36Z","timestamp":1790796936619,"version":"4.1.0"},"reference-count":55,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ EBM"],"accepted":{"date-parts":[[2026,5,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Migraine headaches are common and potentially disabling disorders, with several interventions available for prevention and symptom reduction. We explored the comparative effectiveness and tolerability of pharmacological prophylaxis for migraine through a network meta-analysis of randomised trials (RCTs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Our study design was a systematic review and network meta-analysis (PROSPERO registration CRD42023456915).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>We included randomised controlled trials of prophylactic pharmacological interventions that enrolled adults diagnosed with chronic and\/or episodic migraine headaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Medline, Embase, Cochrane Central, PsycINFO, Web of Science and Scopus from inception to 15 January 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Risk of bias and certainty evidence<\/jats:title>\n                    <jats:p>Risk of bias was assessed using the modified Cochrane risk-of-bias tool 2.0 and the certainty evidence was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Synthesis of results<\/jats:title>\n                    <jats:p>We performed a frequentist network meta-analysis using a random-effects model to compare the efficacy of interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 199 RCTs (47\u2009420 participants). Overall, 29 trials (14.6%) were at low risk of bias; an adequate random allocation sequence generation was reported in 92 trials (46.2%), and missing outcome data was the most common limitation (110 trials, 55.3%). Compared with placebo, calcium channel blockers (mean difference (MD) \u22121.78 (95% CI \u22122.96 to \u22120.60), moderate certainty), calcitonin gene-related peptide (CGRP)-targeted therapies (MD \u22121.69 (95% CI \u22122.16 to \u22121.23), high certainty) and beta-blockers (MD \u22121.50 (95% CI \u22122.54 to \u22120.47), moderate certainty) were the most effective in reducing monthly migraine days. Moderate certainty evidence suggests beta-blockers (MD \u22121.31 (95% CI \u22121.76 to \u22120.85)), calcium channel blockers (MD \u22121.11 (95% CI \u22121.65 to \u22120.57)), anticonvulsants (MD \u22121.12 (95% CI \u22121.66 to \u22120.58)) and CGRP-targeted therapies (MD \u22120.76 (95% CI \u22121.49 to \u22120.02)) probably reduce monthly migraine attacks. However, moderate to high certainty evidence found that patients were more likely to discontinue calcium channel blockers (relative risk (RR) 1.40, 95%\u2009CI 1.04 to 1.88)\u2009and anticonvulsants (RR 1.14, 95%\u2009CI 1.01 to 1.29), compared with placebo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>When restricted to moderate or high certainty evidence, beta-blockers and CGRP-targeted therapies probably reduce migraine frequency and may be well-tolerated prophylactic options for migraine. Calcium channel blockers and anticonvulsants may also be effective for reducing migraine frequency but are less well tolerated by some patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42023456915.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjebm-2025-114222","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:20:10Z","timestamp":1780507210000},"page":"bmjebm-2025-114222","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness and tolerability of pharmacological prophylaxis for migraine headaches: a systematic review and network meta-analysis of randomised controlled trials"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6160-0913","authenticated-orcid":false,"given":"Malahat","family":"Khalili","sequence":"first","affiliation":[{"name":"Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3912-5874","authenticated-orcid":false,"given":"Faraidoon","family":"Haghdoost","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Liaghatdar","sequence":"additional","affiliation":[{"name":"Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kian","family":"Torabiardakani","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2353-8464","authenticated-orcid":false,"given":"Fatemeh","family":"Mahdian","sequence":"additional","affiliation":[{"name":"School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tal","family":"Levit","sequence":"additional","affiliation":[{"name":"Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Moradi","sequence":"additional","affiliation":[{"name":"Michael G DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehsan","family":"Hedayati","sequence":"additional","affiliation":[{"name":"\u00c9cole d\u2019optom\u00e9trie, Universit\u00e9 de Montr\u00e9al, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzaneh","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"School of Dentistry, Islamic Azad University Shiraz, Shiraz, Fars, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Khademioore","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Atkin-Jones","sequence":"additional","affiliation":[{"name":"Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Patil","sequence":"additional","affiliation":[{"name":"Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Mirzayeh Fashami","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soheil","family":"Mehmandoost","sequence":"additional","affiliation":[{"name":"HIV\/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Kerman, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel J","family":"Couban","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada"},{"name":"Michael G. 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