There is limited evidence supporting the prophylactic use of pharmacological therapies for the prevention of migraine in pediatric patients, according to the findings of a recently published systematic review and network meta-analysis.
Although a large number of pharmacologic treatment options exist for the prevention of migraine, a quantitative comparison evaluating these therapies in children and adolescents is lacking. To investigate the efficacy, safety, and acceptability of prophylactic migraine therapies in this patient population, the authors searched for randomized clinical trials that were then analyzed by 4 independent reviewers. A random-effects model was used to determine effect sizes, which were calculated as standardized mean differences (SMD) for primary end points and risk ratios for rates of discontinuation.
“Primary outcomes were efficacy (ie, migraine frequency, number of migraine days, number of headache days, headache frequency, or headache index), safety (ie, treatment discontinuation owing to adverse events), and acceptability (ie, treatment discontinuation for any reason),” the authors stated.
The analysis, which included 23 studies with a total of 2217 patients, evaluated antiepileptics (pregabalin, sodium valproate, topiramate), antidepressants (amitriptyline), calcium channel blockers (cinnarizine, flunarizine, nimodipine) antihypertensive agents (propranolol), and food supplements (ie, butterbur root extract, coenzyme Q10, melatonin, riboflavin) as prophylactic treatments for pediatric migraine.
Data analysis revealed propranolol and topiramate to be more effective than placebo for migraine prophylaxis in the short-term (<5 months; SMD, 0.60; 95% CI, 0.03-1.17 and SMD, 0.59; 95% CI, 0.03-1.15, respectively), however, the authors noted that based on the prediction interval, these effects were only to be expected in 70% of future studies. Additionally, results of the study also showed that none of the pharmacologic treatments had any significant long-term effects on migraine prevention when compared with placebo.
“According to our results, prophylactic pharmacologic treatments have little evidence supporting efficacy for pediatric migraine,” the authors concluded. They added, “We advise to carefully weigh the benefits of prophylactic medications against their potential harms.”
Locher C, Kossowsky J, Koechlin H, et al. Efficacy, Safety, and Acceptability of Pharmacologic Treatments for Pediatric Migraine Prophylaxis: A Systematic Review and Network Meta-analysis. JAMA Pediatr. Published online February 10, 2020. doi:10.1001/jamapediatrics.2019.5856