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Study Title and Description

Peripheral nerve blocks in the treatment of migraine in pregnancy.



Key Questions Addressed
2 Direct Evidence (Primary Studies): KQ 2 - What are the (comparative) benefits and harms of interventions to treat acute attacks of primary headache in women who are pregnant (or attempting to become pregnant), postpartum, or breastfeeding?
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Primary Publication Information
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TitleData
Title Peripheral nerve blocks in the treatment of migraine in pregnancy.
Author Govindappagari S., Grossman TB., Dayal AK., Grosberg BM., Vollbracht S., Robbins MS.
Country Department of Obstetrics and Gynecology & Women's Health, Montefiore Medical Center, and the Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, New York.
Year 2014
Numbers Pubmed ID: 25415168

Secondary Publication Information
There are currently no secondary publications defined for this study.


Extraction Form: Extraction form for Direct Evidence (Primary Studies)
Arms
Number Title Description Comments
1 Nerve Blocks: Peripheral
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Design Details
Question... Follow Up Answer Follow-up Answer
Which KEY QUESTION (KQ) does this study address? KQ2: Treatment of primary headache
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KQ2: Treatment of primary headache
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What is the STUDY DESIGN? Single group study....Skip to Question 4
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What was the DIRECTIONALITY of the study? Retrospective
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In what COUNTRY was the study done? US
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US
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What was the FUNDING SOURCE of the study? ... Can't tell/Not reported ...
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Does the study have a NAME or ACRONYM? No/not reported
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Does the study have a CLINICALTRIALS.GOV IDENTIFICATION NUMBER? No/not reported
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What were the START and END YEARS of the study? 2009
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2014
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What were the study INCLUSION criteria? Pregnant women with migraine in whom other forms of treatment previously had failed
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What were the study EXCLUSION criteria? NR
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Do you have any NOTES regarding the design or any overall aspects of this study?
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Baseline Characteristics
Question Nerve Blocks: Peripheral Total Comments
AnswerFollow-up AnswerFollow-up
What was the SAMPLE SIZE at baseline? 13 13
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What were the RACE/ETHNICITY of the women in the study? Not reported Not reported
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What was the AGE DISTRIBUTION of the women in the study? (CONTINUOUS data) Mean 28 Mean 28
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Range 18, 36 Range 18, 36
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What was the AGE DISTRIBUTION of the women in the study? (CATEGORICAL data) <20 years <20 years
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15.3 15.3
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20-29 years 20-29 years
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46.1 46.1
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30-40 years 30-40 years
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38.4 38.4
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In what PHASE were the women in the study? Not reported...% Not reported...%
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What was the GESTATIONAL AGE DISTRIBUTION of the women in the study? (CONTINUOUS data) Mean 23.5 Mean 23.5
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Range 7, 37 Range 7, 37
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What was the UNIT for the gestational age you answered in the previous question? Weeks Weeks
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What was the GRAVIDITY DISTRIBUTION of the women in the study? (CONTINUOUS data) Not reported Not reported
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What was the PARITY DISTRIBUTION of the women in the study? (CONTINUOUS data) Not reported Not reported
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What were the TYPES of PRIMARY HEADACHE in the women in the study? Migraine...% 100 Migraine...% 100
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What percentage of the women in the study had a HISTORY OF PRIMARY HEADACHE? Not reported Not reported
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Do you have any NOTES regarding the baseline characteristics in this study? No data entered.



Results & Comparisons


Results Data
Outcome: Adverse events - Fetal/Infant - Preterm birth      Population: All Participants
Time Point Measure Nerve Blocks: Peripheral


29 weeks

N Analyzed 13
Counts 2
Percentage 15.3
Outcome: Adverse events - Maternal - Serious      Population: All Participants
Time Point Measure Nerve Blocks: Peripheral


Postprocedure N/A

N Analyzed 13
Counts 0
Percentage 0
Outcome: Adverse events - Maternal - Other      Population: All Participants
Time Point Measure Nerve Blocks: Peripheral


Postprocedure N/A

N Analyzed 13
Counts 1
Percentage 7.7
Outcome: Acute headache attacks - Severity      Population: All Participants
Time Point Measure Nerve Blocks: Peripheral


Baseline N/A

N Analyzed 13
Mean 8.4
SD 1.8


Postprocedure N/A

N Analyzed 13
Mean 4.5
SD 3.8


24 hours

N Analyzed 13
Mean 4.5
SD 4.5
Within-Arm Comparisons
Comparison Measure Nerve Blocks: Peripheral
Postprocedure N/A vs. Baseline N/A Mean Difference -4.0
SD 2.6
N Analyzed 13
P-Value <0.001


Quality Dimensions
Dimension Value Notes Comments
Q1: ROBINS-I 1.1 Is there potential for confounding of the effect of intervention in this study?
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Q2: Did the study divide the follow up time of each individual participant into the different interventions?
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Q3: ROBINS-I 1.4. Did the authors use an appropriate analysis method that controlled for all the important confounding domains?
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Q4: ROBINS-I 1.5. If Y/PY to 1.4: Were confounding domains that were controlled for measured validly and reliably by the variables available in this study?
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Q5: ROBINS-I 1.6. Did the authors control for any post-intervention variables that could have been affected by the intervention?
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Q6: Risk of bias judgement for BIAS DUE TO CONFOUNDING
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Q7: ROBINS-I 2.1. Was selection of participants into the study (or into the analysis) based on participant characteristics observed after the start of intervention?
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Q8: ROBINS-I 2.2. If Y/PY to 2.1: Were the post-intervention variables that influenced selection likely to be associated with intervention?
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Q9: ROBINS-I 2.3 If Y/PY to 2.2: Were the post-intervention variables that influenced selection likely to be influenced by the outcome or a cause of the outcome?
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Q10: ROBINS-I 2.4. Do start of follow-up and start of intervention coincide for most participants?
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Q11: Did the start and follow up calendar years coincide for most participants in the study?
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Q12: ROBINS-I 2.5. If Y/PY to 2.2 and 2.3, or N/PN to 2.4: Were adjustment techniques used that are likely to correct for the presence of selection biases?
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Q13: ROBINS-I - Risk of bias judgement for BIAS IN SELECTION OF PARTICIPANTS INTO THE STUDY
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Q14: Cochrane - Random sequence generation (selection bias): Selection bias (biased allocation to interventions) due to inadequate generation of a randomized sequence
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Q15: Cochrane - Allocation concealment (selection bias): Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment
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Q16: Cochrane - Blinding of participants (performance bias): Performance bias due to knowledge of the allocated interventions by participants during the study
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Q17: Cochrane - Blinding of personnel/ care providers (performance bias): Performance bias due to knowledge of the allocated interventions by personnel/care providers during the study.
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Q18: Cochrane - FOR OBJECTIVE OUTCOMES - Blinding of outcome assessor (detection bias): Detection bias due to knowledge of the allocated interventions by outcome assessors.
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Q19: Cochrane - FOR SUBJECTIVE OUTCOMES - Blinding of outcome assessor (detection bias): Detection bias due to knowledge of the allocated interventions by outcome assessors.
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Q21: Cochrane - Selective Reporting (reporting bias): Reporting bias due to selective outcome reporting Low
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Q20: Cochrane - Incomplete outcome data (attrition bias): Attrition bias due to amount, nature or handling of incomplete outcome data Low
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Q22: Cochrane - Other Bias: Bias due to problems not covered elsewhere in the table. If yes, describe them in the Notes. Low
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Q23: NHLBI - Were eligibility/selection criteria for the study population prespecified and clearly described? No Unclear what severity of migraine or trimester women would be eligible
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Q24: NHLBI - Was the test/service/intervention clearly described and delivered consistently across the study population? Yes
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Q25: NHLBI - Were the outcome measures prespecified, clearly defined, valid, reliable, and assessed consistently across all study participants? Yes
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Quality Rating
No quality rating data was found.