Oral Chinese Herbal Medicine as Prophylactic Treatment for Episodic Migraine in Adults: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Abstract

Background. The prophylactic effects of Chinese herbal medicine (CHM) for migraine were examined in numerous clinical trials. This review aimed to analyze the effectiveness and safety of CHM as prophylactic treatment of migraine compared to flunarizine. Methods. Nine databases were searched for randomized controlled trials (RCTs) that evaluated effects of CHM for episodic migraine prophylaxis compared to flunarizine, published before March 2019. Results. Thirty-five RCTs with 2,840 participants met the inclusion criteria, and 31 of them were included in meta-analyses. The overall meta-analysis indicated that, when compared to flunarizine, CHM reduced the frequency of migraine attacks at the end of treatment (EoT) (21 studies, mean difference (MD) −1.23, 95% confidence interval (CI) (−1.69, −0.76)) and at the end of follow-up (EoFU) (five studies, MD −0.96, 95% CI (−1.70, −0.21)). Subgroup analyses based on the treatment duration, follow-up duration, and the dosage of flunarizine showed that CHM was superior to or comparable with flunarizine in reducing migraine frequency. Similar results were also found for secondary outcomes such as the pain visual analogue scale, migraine duration, responder rate, and acute medication usage. In particular, the studies that used CHM containing herb pairs (Chuan Xiong plus Bai Zhi and Chuan Xiong plus Tian Ma) showed promising results. However, the certainty of this evidence was evaluated as “low” or “very low” using the Grading of Recommendations, Assessment, Development and Evaluations approach. Conclusion. CHM appeared to be comparable with flunarizine in reducing the frequency of episodic migraine attacks in adults at EoT and EoFU and well-tolerated by participants, regardless of the treatment duration, follow-up duration, and dosage of flunarizine. Due to the low certainty of the evidence, the suggested promising prophylactic outcomes require higher quality evidence from further rigorous RCTs.

Efficacy and Safety of Oral Chinese Herbal Medicine for Migraine: A Systematic Review and Meta-Analyses Using Robust Variance Estimation Model

“…Chuan xiong was the most popular used herb for migraine among the included RCTs, this is consistent with the findings of previous studies (14,(55)(56)(57). In addition, we found that chuan xiong and bai zhi and chuan xiong and dang gui were the two mostly used herb pairs for migraine management.…”

“…As a commonly used complementary therapy for migraine management in China (12), the benefits, safety, and economic cost induced by CHM remain in heated debates (12). Although the efficacy and effectiveness of CHM for migraine were supported by previous research (13)(14)(15)(16)(17), it remains inconclusive in terms of whether CHM should be used solely or in combination with conventional pharmacotherapies for migraine in real-world clinical practice, due to the low quality of the above evidence. In addition, it is widely recognized that preventive treatments should take patients' preferences, proven efficacy, and drug side effects into consideration in migraine management (18), which is consistent with the concept of evidence-based practice (64).…”

“…In China, over 60% of migraine patients seek Chinese medicine therapies, including Chinese herbal medicine (CHM), for migraine management (12). Research evidence demonstrated that oral CHM was comparable with or superior to conventional pharmacotherapies including flunarizine (13)(14)(15), and produced significant add-on effects when it was used in combination with conventional pharmacotherapies for migraine (13,16). Two systematic reviews concluded that oral CHM was more efficacious than placebo as prophylactic management for migraine (15,17).…”

Migraine patients visiting Chinese medicine hospital: Protocol for a prospective, registry-based, real-world observational cohort study

“…Chinese herbal medicine (CHM), which is often prescribed to migraine patients in China [25], has gained clinical research evidence as an effective alternative or complementary therapy for migraine in recent years. However, most of the existing evidence has been generated from randomised controlled trials (RCTs) [26][27][28][29][30] and RCT-based systematic reviews [31][32][33][34]. Under controlled settings, RCTs usually apply strict selection criteria and provide unified treatments to all participants [35].…”

Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications

“…The diversity of pathologies covered by the remaining articles is considerable, with three articles related to cancer (involving 54, 14 and 18 RCTs)[33][34][35], three related to hypertension (involving 30, 17 and 39 RCTs)[36][37][38], three related to COVID-19 (involving 19, 7 and 18 RCTs)[39][40][41], two related to depression (involving 40 and 16 RCTs)[42,43], two related to headache (involving 31 and 30 RCTs)[44,45], and the others related to allergic rhinitis (involving 17 RCTs)[46], spinal cord injury (involving 26 RCTs)…”