Basel, Switzerland—While the prevalence of migraines is 7.7% overall in pediatric patients, it increases with age, from 3% in young children, those aged 3 to 7 years, to 8% to 23% in adolescents aged 11 to 15 years or older.

Treatment options for children and adolescents have been largely based on adult studies, according to a study in JAMA Pediatrics. Although the FDA has approved individual triptan and combination products for adolescent migraine, other pharmacologic interventions often are used off-label in clinical practice.

In light of that, University of Basel–led researchers sought to determine the most effective, safe, and accepted pharmacologic treatments for migraine prophylaxis in children and adolescents. To do that, they conducted a systematic review and network meta-analysis of studies in MEDLINE, Cochrane, Embase, and PsycINFO published through July 2, 2018.

Included were randomized clinical trials of prophylactic pharmacologic treatments in children and adolescents diagnosed as having episodic migraine.

Defined as the primary outcomes:
• Efficacy (i.e., migraine frequency, number of migraine days, number of headache days, headache frequency, or headache index)
• Safety (i.e., treatment discontinuation owing to adverse events)
• Acceptability (i.e., treatment discontinuation for any reason)

Ultimately, 23 studies involving 2,217 patients were deemed eligible for inclusion. Prophylactic pharmacologic treatments included in the studies were antiepileptics, antidepressants, calcium channel blockers, antihypertensive agents, and food supplements.

Results indicate that, in the short term of fewer than 5 months, propranolol (standard mean difference, 0.60; 95% CI, 0.03-1.17) and topiramate (standard mean difference, 0.59; 95% CI, 0.03-1.15) were significantly more effective than placebo. Longer term, no significant long-term effects for migraine prophylaxis relative to placebo were found for any intervention.

“Prophylactic pharmacologic treatments have little evidence supporting efficacy in pediatric migraine,” the researchers conclude. “Future research could (1) identify factors associated with individual responses to pharmacologic prophylaxis, (2) analyze fluctuations of migraine attack frequency over time and determine the most clinically relevant length of probable prophylactic treatment, and (3) identify nonpharmacologic targets for migraine prophylaxis.”

“Our study therefore shows that the preventive pharmacological treatment of pediatric migraine with all these drugs is barely more effective than placebo,” explained Cosima Locher, PhD, from the Faculty of Psychology at the University of Basel.

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