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Table 2 Assessment of certainty of evidence using the GRADE evidence profile

From: The association between endometriosis and migraine: a systematic review and meta-analysis of observational studies

Certainty assessment

No of patients

Effect

Certainty

No of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

endometriosis

control

Relative

(95% CI)

Absolute

(95% CI)

 

Migraine

13

Observational studies

very seriousa

not serious

seriousb

not serious

strong association

2,859/32,489 (8.8%)

12,030/299,166 (4.0%)

OR 2.25

(1.85 to 2.72)

46 more per 1,000

(from 32 more to 62 more)

Lowa, b

Migraine without aura

3

Observational studies

very seriousc

not serious

seriousb

not serious

strong association

137/482 (28.4%)

63/488

(12.9%)

OR 2.64

(1.89 to 3.69)

152 more per 1,000

(from 90 more to 224 more)

Very lowb, c

Migraine with aura

3

Observational studies

very seriousc

seriousd

seriousb

very seriouse

limited evidence, heterogeneity of findings

28/482

(5.8%)

8/488

(1.6%)

OR 3.47

(0.53 to 22.89)

37 more per 1,000

(from 7 fewer to 255 more)

Very lowb, c,d, e

  1. CI: confidence interval; OR: odds ratio
  2. Explanations
  3. a. 50% of studies (n = 7) at very high risk of bias, 21% (n = 3) at high risk of bias, 14.5% of studies (n = 3) rated as ‘some concerns’, and 14.5% (n = 3) at low risk of bias
  4. b. Multiple diagnostic methods accepted, various population settings (e.g. neurology clinic), not all studies excluded endometriosis in the control group (e.g. negative laparoscopy)
  5. c. 67% (n = 2) rated as ‘some concerns’ and 33% (n = 1) at very high risk of bias
  6. d. One study found similar rates in both groups
  7. e. 95% CI 0.53–22.89