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García-Azorin D, Yamani N, Messina LM, Peeters I, Ferrili M, Ovchinnikov D, Speranza ML, Marini V, Negro A, Benemei S, Barloese M. A PRISMA-compliant systematic review of the endpoints employed to evaluate symptomatic treatments for primary headaches. J Headache Pain 2018; 19:90. [PMID: 30242571 PMCID: PMC6742919 DOI: 10.1186/s10194-018-0920-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/14/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Primary headache are prevalent and debilitating disorders. Acute pain cessation is one of the key points in their treatment. Many drugs have been studied but the design of the trials is not usually homogeneous. Efficacy of the trial is determined depending on the selected primary endpoint and usually other different outcomes are measured. We aim to critically appraise which were the employed outcomes through a systematic review. METHODS We conducted a systematic review of literature focusing on studies on primary headache evaluating acute relief of pain, following the PRISMA guideline. The study population included patients participating in a controlled study about symptomatic treatment. The comparator could be placebo or the standard of care. The collected information was the primary outcome of the study and all secondary outcomes. We evaluated the studied drug, the year of publication and the type of journal. We performed a search and we screened all the potential papers and reviewed them considering inclusion/exclusion criteria. RESULTS The search showed 4288 clinical trials that were screened and 794 full articles were assessed for eligibility for a final inclusion of 495 papers. The studies were published in headache specific journals (58%), general journals (21.6%) and neuroscience journals (20.4%). Migraine was the most studied headache, in 87.8% studies, followed by tension type headache in 4.7%. Regarding the most evaluated drug, triptans represented 68.6% of all studies, followed by non-steroidal anti-inflammatories (25.1%). Only 4.6% of the papers evaluated ergots and 1.6% analyzed opioids. The most frequent primary endpoint was the relief of the headache at a determinate moment, in 54.1%. Primary endpoint was evaluated at 2-h in 69.9% of the studies. Concerning other endpoints, tolerance was the most frequently addressed (83%), followed by headache relief (71.1%), improvement of other symptoms (62.5%) and presence of relapse (54%). The number of secondary endpoints increased from 4.2 (SD = 2.0) before 1991 to 6.39 after 2013 (p = 0.001). CONCLUSION Headache relief has been the most employed primary endpoint but headache disappearance starts to be firmly considered. The number of secondary endpoints increases over time and other outcomes such as disability, quality of life and patients' preference are receiving attention.
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Affiliation(s)
- D. García-Azorin
- Headache Unit Neurology Department, Hospital Clínico Universitario Valladolid, Avda. Ramón y Cajal 3, 47005 Valladolid, Spain
| | - N. Yamani
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, Denmark
- Headache Department, Iranian Center of Neurological Research Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - L. M. Messina
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
- U.O. Neuropsychiatry - ARNAS Civico, PO Di Cristina, Palermo, Italy
| | - I. Peeters
- Neurology Department, University Hospital of Brussels, Brussels, Belgium
| | - M. Ferrili
- Headache Center, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - D. Ovchinnikov
- Pavlov First Saint Petersburg State Medical University, Saint Petesburg, Russia
- Almazov National Medical Research Centre, Saint Petesburg, Russia
| | - M. L. Speranza
- Internal Medicine Department, Sant’Andrea Hospital, Rome, Italy
| | - V. Marini
- Internal Medicine Department, Sant’Andrea Hospital, Rome, Italy
| | - A. Negro
- Regional Referral Headache Centre, Sant’Andrea Hospital, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - S. Benemei
- Headache Centre, Careggi University Hospital, University of Florence, Florence, Italy
| | - M. Barloese
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging, Hvidovre Hospital, Copenhagen, Denmark
| | - on behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
- Headache Unit Neurology Department, Hospital Clínico Universitario Valladolid, Avda. Ramón y Cajal 3, 47005 Valladolid, Spain
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, Denmark
- Headache Department, Iranian Center of Neurological Research Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
- U.O. Neuropsychiatry - ARNAS Civico, PO Di Cristina, Palermo, Italy
- Neurology Department, University Hospital of Brussels, Brussels, Belgium
- Headache Center, Bambino Gesù Children Hospital IRCCS, Rome, Italy
- Pavlov First Saint Petersburg State Medical University, Saint Petesburg, Russia
- Almazov National Medical Research Centre, Saint Petesburg, Russia
- Internal Medicine Department, Sant’Andrea Hospital, Rome, Italy
- Regional Referral Headache Centre, Sant’Andrea Hospital, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- Headache Centre, Careggi University Hospital, University of Florence, Florence, Italy
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging, Hvidovre Hospital, Copenhagen, Denmark
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