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Migraine in Children: Preventive Pharmacologic Treatments [Internet]

Migraine in Children: Preventive Pharmacologic Treatments [Internet]

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US)

Version: June 2013

Discussion

Our comprehensive review identified limited evidence about benefits and harms with migraine preventive drugs in children. Migraine prevention in children was examined in 24 publications of 22 RCTs that enrolled 1,578 children. Only one drug, the beta blocker propranolol, prevented migraine more effectively than placebo (Table 14). Propranolol (60 to 120 mg/day) would result in complete cessation of migraine attacks in 713 per 1,000 treated children (95% CI, 452 to 974) (low-strength evidence from a single RCT). Topiramate, divalproex, clonidine, trazodone, and magnesium oxide failed to prevent migraine in children. Divalproex sodium, 1000 mg/day, resulted in greater rates of treatment discontinuation due to adverse effects (Table 12). Topiramate significantly increased risk of weight loss, paresthesia, and upper respiratory tract infection (Table 13).

Results

Of 510 retrieved references, we excluded 104 at screening as not relevant to pediatric migraine, and we reviewed full texts of 312 references (Figure 2). We ultimately included 24 references of randomized controlled clinical trials, two abstracts of randomized controlled clinical trials, and 16 nonrandomized studies. We did not rank strength of evidence for two RCTs of flunarizine because, despite being commonly used elsewhere, this drug is not approved by the FDA. We found one eligible FDA review that evaluated a clinical trial of divalproex sodium used to prevent migraine headache in adolescents.

Executive Summary

The Agency for Healthcare Research and Quality (AHRQ) commissioned the Minnesota Evidence-based Practice Center (EPC) to conduct a review of preventive pharmacologic treatments for migraine. This review of migraine prevention is presented in two parallel reports, one focusing on children and one on adults. Here we address migraine prevention in children 6 to 18 years old.

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