Article

Acute treatment of paediatric migraine: a meta-analysis of efficacy. J Paediatr Child Health 44(1-2):3-9

Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Journal of Paediatrics and Child Health (Impact Factor: 1.19). 02/2008; 44(1-2):3-9. DOI: 10.1111/j.1440-1754.2007.01206.x
Source: PubMed

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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    • "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]. "
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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 [11]. 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. "
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