Acute treatment of paediatric migraine: a meta-analysis of efficacy. J Paediatr Child Health 44(1-2):3-9
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.
- SourceAvailable from: Francesco Nicita
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- "Ibuprofen (10 mg/kg) and acetaminophen (15 mg/kg) were more effective than placebo; the effect yielded by ibuprofen at 2 h was better than that of acetaminophen (68 vs. 54% of children relieved) and lasted longer. Neither drug had significant side effects [11, 17]. "
ABSTRACT: There is a serious lack of controlled studies on the pharmacological treatment of primary migraine in the developmental age; there is, consequently, an urgent need for new, evidence-based approaches to this long-neglected field of research. Moreover, previous studies have stated that the placebo response is greater in pediatric patients than in adults and that a reduction in the attack frequency in the absence of any pharmacological treatment is observed more frequently in pediatric migraine patients than in adults. Besides these preliminary considerations, the shorter duration of migraine attacks and other characteristic semeiological features of the clinical picture in children are such that the design of randomized controlled trial (RCT) is more problematic in the developmental age than in the adult. Bearing in mind all these weak points, the aim of this review was to summarize and update recent guidelines for the treatment of primary migraine in children and adolescents. The most recent guidelines are those published by the Italian Society for the study of Headache, the French Society for the study of Migraine and Headache, and the American Academy of Neurology. We have incorporated into these guidelines the results from the few, recent RCTs, clinical controlled trials, open-label studies, meta-analyses and reviews that have been published since 2004; owing to the lack of strong evidence in this field of research, we have sometimes even mentioned pilot non-controlled studies, case series and expert opinions. Lastly, evidence was classified and the recommendations were categorized according to different levels.The Journal of Headache and Pain 03/2010; 11(3):267-76. DOI:10.1007/s10194-010-0205-4 · 3.28 Impact Factor
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- "In children of age 6–12 years, both paracetamol at 15 mg/kg per dose or the non-steroidal anti-inflammatory drug ibuprofen at 7.5–10 mg/kg per dose, taken when needed, are effective and well tolerated [9, 10]. For the acute treatment of migraine in adolescents of age 12–17 years, in addition to ibuprofen, sumatriptan nasal spray at doses of 5–20 mg is effective and well tolerated . Triptans, migraine-specific medications, may be added to the treatment plan when children have a moderate-to-severe migraine, when the response to ibuprofen is either incomplete or ineffective. "
ABSTRACT: The aim of this 6-month, prospective, multicenter study of 398 children and adolescents with primary headaches was to collect data on headache treatment in neuropediatric departments. Treatments were compared before and after consultation. Prior to consultation, the acute treatments that had been prescribed most frequently were paracetamol (82.2% of children) and non-steroidal anti-inflammatory drugs treatment (53.5%); 10.3% had received a prophylactic treatment. No differences in either acute or prophylactic treatment with respect to headache diagnosis were observed. After the neuropediatric consultation, paracetamol was replaced by a non-steroidal anti-inflammatory drug in about three-quarters of cases and by triptan in about one-quarter of cases. The number of children prescribed a prophylactic treatment nearly doubled, whereas there was a 5-fold and 23-fold increase in psychotherapy and relaxation training, respectively, between pre-referral and referral. We conclude that specific treatments were underused for primary headache.The Journal of Headache and Pain 09/2009; 10(6):447-53. DOI:10.1007/s10194-009-0158-7 · 3.28 Impact Factor