Symptomatic Treatment of Migraine in Children: A Systematic Review of Medication Trials

Abstract

ABSTRACT. Objective. Treatment of pediatric migraine includes an individually tailored regimen of both nonpharmacologic and pharmacologic measures. The mainstay of symptomatic treatment in children with migraine is intermittent oral or suppository analgesics, but there is no coherent body of evidence on symptomatic treatment of childhood migraine available. The objective of this review is to describe and assess the evidence from randomized and clinical controlled trials concerning the efficacy and tolerability of symptomatic treatment of migraine in children.Design. Systematic review according to the standards of the Cochrane Collaboration.Methods. Databases were searched from inception to June 2004. Additional reference checking was performed. Two authors independently selected randomized and controlled trials evaluating the effects of symptomatic treatment in children (<18 years old) with migraine, using headache (HA) clinical improvement as an outcome measure. Two authors assessed trial quality independently by using the Delphi list, and data were extracted from the original reports by using standardized forms. Quantitative and qualitative analysis was conducted according to type of intervention.Results. A total of 10 trials were included in this review, of which 6 studies were considered to be of high quality. The number of included participants in each trial ranged from 14 to 653, with a total of 1575 patients included in this review. Mean dropout rate was 19.8% (range: 0 -39.1%), and the mean age of participants was 11.7 ؎ 2.2 years (range: 4 -18 years).All studies used HA diaries to assess outcomes. In most studies, a measure of clinical improvement was calculated by using these diaries. Improvement often was regarded as being clinically relevant when the patients' HA declined by >50%.Regarding oral analgesic treatment, the effectiveness of acetaminophen, ibuprofen, and nimesulide were evaluated. When compared with placebo, acetaminophen (relative risk [RR]: 1.5; 95% confidence interval [CI]: 1.0 -2.1) and ibuprofen (pooled RR: 1.5; 95% CI: 1.2-1.9) significantly reduced HAs. We conclude that there is moderate evidence that both acetaminophen and ibuprofen are more effective in reduction of symptoms 1 and 2 hours after intake than placebo with minor adverse effects. No clear differences in effect were found between acetaminophen and ibuprofen or nimesulide.Regarding the nonanalgesic interventions, nasal-spray sumatriptan, oral sumatriptan, oral rizatriptan, oral dihydroergotamine, intravenous prochlorperazine, and ketorolac were evaluated. When compared with placebo, nasal-spray sumatriptan (pooled RR: 1.4; 95% CI: 1.2-1.7) seemed to significantly reduce HAs. We conclude that there is moderate evidence that nasal-spray sumatriptan is more effective in reduction of symptoms than placebo but with significantly more adverse events. No differences in effect were found between oral triptans and placebo. All medications were well tolerated, but significantly more adverse events were reported for nasalspray suma...

Evolution of paediatric off‐label use after new significant medicines become available for adults: a study on triptans in Finnish children 1994–2007

“…This has been the case although triptans represented a therapeutic benefit over existing treatments and migraine is not uncommon in the paediatric population. No official recommendations on triptan use in children were given during the study period, but several papers reviewing the treatment options and medical trials were published [18][19][20][21][22][23][24][25].…”

“…It is generally accepted that NSAIDs, like ibuprofen, and acetaminophen (paracetamol), with demonstrated efficacy [31], represent the first line of treatment of paediatric migraine. It has been estimated that 30% to 60% of paediatric migraine patients need alternative treatments to the NSAIDs [32].…”

A Review of the Pharmacokinetics, Pharmacodynamics and Efficacy of Zolmitriptan in the Acute Abortive Treatment of Migraine

“…47 Although zolmitriptan is not FDA approved for use in adolescents, these studies suggest that zolmitriptan does have effi cacy for treatment of acute migraine in adolescents; and in pediatric patients who do not respond to NSAIDS, triptans such as zolmitriptan may be effective. [108][109][110] Effi cacy in cluster headache…”

The evaluation and management of paediatric headaches

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