Prophylaxis for pediatric migraine is ineffective

  • JAMA Pediatr

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • A meta-analysis shows that prophylactic pharmacological treatment for pediatric migraine, including β-blockers, anticonvulsants, antidepressants, and antihistaminic and calcium channel blockers, offers no significant benefit over placebo.

Why this matters

  • Migraines are common in children, with the incidence increasing as children age, but most treatment options are based on studies in adults.

Study design

  • A systematic review and network meta-analysis (NMA) of 23 randomized clinical trials of prophylactic pharmacologic treatments for episodic migraine in children and adolescents aged
  • Funding: Sara Page Mayo Endowment for Pediatric Pain Research, Education, and Treatment.

Key results

  • Antiepileptics, antidepressants, calcium channel blockers, antihypertensive agents, and food supplements were studied.
  • When combined in NMA there was a significant effect of:
    • Propranolol: 0.60 (95% CI, 0.03-1.17).
    • Topiramate: 0.59 (95% CI, 0.03-1.15).
  • Nonsignificant 95% prediction intervals were noted with:
    • Propranolol vs placebo: −0.62 to 1.82.
    • Topiramate vs placebo: −0.62 to 1.80.
  • Other interventions showed nonsignificant standardized mean differences:
    • Range was −0.21 (95% CI, −1.40 to 0.99) for L-5-hydroxytryptophan to 0.93 (95% CI, −0.12 to 1.98) for flunarizine.

Limitations

  • Most substances were tested in

Coauthored with Chitra Ravi, MPharm