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High-dose atorvastatin reduces periodontal inflammation, suggesting a newly recognized effect of statins. Given the concomitant changes observed in periodontal and arterial inflammation, these data raise the possibility that a portion of that beneficial impact of statins on atherosclerosis relate to reductions in extra-arterial inflammation, for example, periodontitis. (Evaluate the Utility of 18FDG-PET as a Tool to Quantify Atherosclerotic Plaque; NCT00703261).

Background Childhood migraines are a common source of morbidity. Purpose To assess the comparative effectiveness and side effects of migraine prophylactic medications in children. Data Sources PUBMED, EMBASE, Cochrane Trial Registry, bibliography of retrieved articles through 25 April 2012. Study Selection Randomized trials of children with migraine headaches. Data Extraction Extracted independently in duplicate, including quality (JADAD, Cochrane Risk of Bias). We pooled headache frequency per month using random effects methods. Data Synthesis Among 21 included trials, there were 13 placebo controlled and 11 comparative effectiveness trials (3 included placebo arms. Drugs more effective than placebo for episodic migraines (<15 headaches/month) included topiramate (−0.71 headaches/month, 95 % CI: −1.19 to −0.24, Q= 1.58, df=1, I2=0.0%) and trazodone (−0.60 headache/month, 95% CI: −1.09 to −0.11, 1 study, Figure 2). Ineffective drugs included clonidine, flunarizine, pizotifen, propranolol and valproate. A single trial of fluoxetine for chronic daily headaches found it ineffective. Patients given placebo experienced a significant (p=0.027) decline in headaches from 5.6 (95% CI: 4.52–6.77 Q=8.14, df=8, I2=1.7%) to 2.9 headaches/month (95% CI: 1.66–4.08, Q-4.72, df=10, I2=0.0%). Among the 10 comparative effectiveness trials, flunarizine was more effective than piracetam (−2.2 headaches/month, 9 CI: −3.93 to −0.47), but no better than aspirin, dihydroergotamine, and propranolol. Propranolol was compared to valproate as well as behavioral treatment and two studies compared different doses of topiramate; none of these trials showed a significant difference. Limitations Few trials, lack of patient level data, changing definitions of migraine over time, few comparative effectiveness trials. Conclusion Topiramate and trazodone have limited evidence supporting efficacy for episodic migraines. Placebo was effective in reducing headaches. Other commonly used drugs have no evidence supporting their use in children. Research in pediatric headaches is needed.

This study supports the hypothesis that AS is an inflammatory condition and suggests that inflammation may be reduced in late-stage disease. This may have important implications in the design of studies assessing the effect of therapeutic agents in modifying progression of AS.