Acute Treatment Therapies for Pediatric Migraine: A Qualitative Systematic Review

Abstract

Of the available evidence, ibuprofen, prochlorperazine, and certain triptan medications are the most effective and safe agents for acute management of migraine and other benign headache disorders in the pediatric population. Additional studies in this population are needed, and should take into consideration variables such as dosing, co-administered medications, treatment duration, and length of treatment effect.

Managing Pediatric Pain in the Emergency Department

“…A recent systematic review evaluated the efficacy and safety of available treatments for children with migraine or benign primary headache in the ED [65]. The authors concluded that ibuprofen, prochlorperazine, and certain triptan medications were the most effective and safe medications for the acute management of migraine and other benign headache disorders in children in the ED [65].…”

“…A recent systematic review evaluated the efficacy and safety of available treatments for children with migraine or benign primary headache in the ED [65]. The authors concluded that ibuprofen, prochlorperazine, and certain triptan medications were the most effective and safe medications for the acute management of migraine and other benign headache disorders in children in the ED [65]. The authors considered the following triptans effective in adolescents: almotriptan, rizatriptan, zolmitriptan by nasal spray, sumatriptan by nasal spray, and a combination of sumatriptan and naproxen [65].…”

“…The authors concluded that ibuprofen, prochlorperazine, and certain triptan medications were the most effective and safe medications for the acute management of migraine and other benign headache disorders in children in the ED [65]. The authors considered the following triptans effective in adolescents: almotriptan, rizatriptan, zolmitriptan by nasal spray, sumatriptan by nasal spray, and a combination of sumatriptan and naproxen [65]. However, as pointed out in an earlier systematic review, the studies included in this systematic review were home rescue therapy [66].…”

“…One RCT evaluated oral dihydroergotamine for inpatients [68]. The evidence for ibuprofen and triptans is limited to patients enrolled at outpatient headache clinics and treated at home during their migraine episodes [65]. Whether the results can be applied to patients seen in the ED is unclear, as these patients are likely to have failed home treatments or to be children who present with a migraine-like episode not yet diagnosed.…”

Have You Got the Power? Why Statistical Power Calculations Are Critical to Research Design

“…Even in the highest impact journals, many trialists continue to inadequately report or calculate sample sizes . In the headache literature, one needs to look no further than recent systematic reviews to understand the commonality of underpowered studies …”