Migraine headache is a disabling condition that affects one in six Americans. Making sense of research results for the many treatments available for migraine is complicated.

To help patients and healthcare professionals understand study results and make the most informed treatment decisions, PCORI has funded the development of an interactive evidence visualization that presents findings from research on drugs and devices for the prevention of migraine. This evidence map and visualization and corresponding report summarize the findings of a systematic rapid review representing a total of 203 randomized controlled trials (RCTs).

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This project assessed the benefits and harms of established and newer migraine prevention therapies to inform decisions and identify important gaps in the evidence. The objectives were to:

• Document and index the volume of RCTs (inactive controls and comparative clinical effectiveness studies) that assessed pharmacologic and device therapies for prevention of episodic and chronic migraine
• Visually display the benefits and harms (from RCTs) of newer therapies for migraine prevention in patients who experience episodic or chronic migraine and benchmark these findings to established therapies recognized by clinical practice guidelines

Across three interactive visualizations, users can drill down using features like filters and tool tips to gain more information about therapies or trials of interest, such as the quality of the evidence or the number of participants randomized to a specific therapy.

About Migraine Prevention

Although many available therapies for migraine prevention exist that show some evidence of benefit, for clinicians and patients looking to select a therapy the plethora of options can make decision making a challenge. Many first-line medications used to prevent episodic migraine (fewer than 15 migraine days per month) and chronic migraine (15 or more migraine days per month) were initially developed to treat other health conditions, such as depression or high blood pressure, and carry risks of side effects that may not be tolerable for migraine patients.

What the Evidence Shows

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Overall, evidence on the benefits and harms of therapies for reducing migraine in patients living with episodic migraine) or chronic migraine is frequently sparse and often based on few and very low-quality, short trials (less than 12 weeks).

Episodic migraine: High-quality evidence supported two treatments (galcanezumab and erenumab) for episodic migraine at all time points evaluated including six months, although the magnitude of improvement could be considered relatively modest (1.85 fewer migraine days per month or less).

In comparison, efficacy for topiramate, propranolol, and amitriptyline (drugs widely used for migraine prevention) ranged from 0.7 to 0.9 fewer migraine days per month when compared to placebo, and adverse effects were common in patients.

Chronic migraine: Three calcitonin gene-related peptide antagonists (eptinezumab, erenumab, and galcanezumab) offered reductions of around 2.6 migraine days per month, with the quality of evidence rated as high.

Future comparative studies comparing established therapies to the newer therapy options are needed to support policy and treatment decisions.

Conclusions and Implications

Interactive evidence visualizations are a new and exciting way to summarize evidence synthesis findings. These tools take complex information and distill it down so that the data is displayed in a visualization that is easy to understand and navigate across diverse user groups. Evidence visualizations may be of interest to researchers, clinicians, policymakers, and even patients, and allow these users to efficiently locate information of interest, like the benefits or harms of a specific therapy, quality of the evidence, or research gaps.

Interactive evidence visualizations are tailored to their respective research questions or topics, are designed to meet the needs of many audiences, and offer the means to quickly gather information for decision making. We look forward to the continued development of these evidence synthesis products to provide stakeholders with meaningful, interactive visualizations supporting evidence-informed decisions.