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.

BackgroundThere is increasing evidence that intestinal inflammation plays a major role in gastrointestinal symptoms in cystic fibrosis (CF). Fecal calprotectin is a marker that is elevated in several gastrointestinal inflammatory diseases, but little is known about its value in CF. We aimed to look for associations of elevated fecal calprotectin among CF patients and whether its level correlates with the clinical manifestations of CF.MethodsA single stool specimen was collected from 62 patients with CF. Fecal calprotectin was measured using the commercially available ELISA kits (PhiCal™ test). Clinical data were collected from patients’ records and CF registry.ResultsThere were no significant differences between CF patients with normal and abnormal fecal calprotectin levels. However, patients who were not receiving inhaled antibiotics had higher fecal calprotectin levels than those who were.ConclusionElevated fecal calprotectin may not accurately predict intestinal inflammation in CF. However, the fact that it was elevated in both pancreatic sufficient and insufficient groups supports the concept of “cystic fibrosis enteropathy” regardless of the pancreatic status.

A large proportion of patients with CAP have deficiencies in disaccharidases. Bowel frequency, vomiting, or location of pain was no different between groups, suggesting that these clinical features cannot be used to predict disaccharidase deficiencies.