Acute treatment of paediatric migraine: a meta-analysis of efficacy.
ABSTRACT To undertake a meta-analysis of all randomised controlled trials (RCTs) on the acute pharmacologic treatment of children and adolescents with migraine headache.
In total, 139 abstracts of clinical trials specific to the acute treatment of paediatric migraine were appraised. Inclusion criteria required clinical trials to be randomised, blinded, placebo-controlled studies with comparable endpoints. Non- English language publications were excluded. 11 clinical trials qualified for inclusion in the final meta-analysis. Two endpoints were analysed: the proportion of patients with (1) headache relief, and (2) complete pain relief, 2 h post-treatment.
The following medications were included in the analysis: acetaminophen (n = 1), ibuprofen (n = 2), sumatriptan (n = 5), zolmitriptan (n = 1), rizatriptan (n = 2) and dihydroergotamine (n = 1). Results are expressed as a relative benefit (RB) conferred over placebo and the number needed to treat (NNT). Only ibuprofen and sumatriptan provided a statistically significant relative efficacy in comparison with placebo. Two hours post-treatment, ibuprofen was associated with an RB 1.50 (95% CI 1.15-1.95) in the generation of headache relief (NNT 2.4) and RB 1.92 (95% CI 1.28-2.86) in the production of complete pain relief (NNT 4.9). Sumatriptan rendered an RB 1.26 (95% CI 1.13-1.41) in headache relief (NNT 7.4) and an RB 1.56 (95% CI 1.26-1.93) in the production of complete pain relief (NNT 6.9).
Despite the pharmacological options for the management of acute migraine, few RCTs in the paediatric population exist. Composite data demonstrate that only ibuprofen and sumatriptan are significantly more effective than placebo in the generation of headache relief in children and adolescents.
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ABSTRACT: The appropriate treatment of migraine requires an individually tailored approach and is based on bio-behavioral, nonpharmacological and pharmacological methods. The available data in the pertinent literature on pharmacologic approaches are few and contradictory. Drug approaches for migraine attack include acetaminophen, NSAIDs and triptans. Acetaminophen and ibuprofen are often effective, but some migraine attacks may be refractory. The triptans can be a useful therapeutic option in adolescents. The literature data on prophylaxis are conflicting: flunarizine and topiramate are probably effective; for other drugs (including cyproheptadine, amitriptyline, divalproate and levetiracetam) there is insufficient evidence in children. The results from the use of propranolol are conflicting, whereas nimodipine and clonidine have been shown to be noneffective. Further studies are needed based on larger samples, multicenter trials, patient selection from primary care centers, and precise respect of current international diagnostic criteria. Moreover, new parameters of treatment efficacy should be considered.Expert Review of Neurotherapeutics 09/2012; 12(9):1133-42. · 2.96 Impact Factor
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