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Table 14Evidence of migraine prevention in children

OutcomeActiveControlRCTs ReferenceConclusionStrength of Evidence (Reason for Lowering)
Complete cessation of headache attacksPropranololPlacebo179Propranolol was better than placebo in achieving complete cessation of migraine attacks.Low
(imprecision)
ClonidinePlacebo171Clonidine was not better than placebo in achieving complete cessation of migraine attacks.Low
(imprecision)
Sodium valproatePropranolol278,88Sodium valproate and propranolol had no significant differences in complete cessation of headache attacks.Low
(medium risk of bias imprecision)
Reduction by 50% in migraine attack frequencyTopiramatePlacebo281,86Topiramate, 50-200 mg/d, did not increase rate of reduction in migraine by ≥50%.Moderate
(medium risk of bias)
Reduction by ≥50% in migraine attack frequencyDivalproex sodiumPlacebo173Divalproex sodium, 250-1,000 mg/d did not increase rate of reduction in migraine by 50%.Low
(imprecision)
1-2 migraine frequency/monthClonidinePlacebo171Clonidine did not increase rate of reduction in migraine.Low
(imprecision)
Reduction by ≥50% in migraine attack frequencySodium valproatePropranolol278,88Sodium valproate and propranolol had no significant differences in reduction of migraine attack by ≥50% from baseline with both drugs.Low
(medium risk of bias, imprecision)
Reduction by ≥50% in migraine attack frequencyMetoprololProgressive relaxation training + stress management175Metoprolol was less effective in reduction by ≥50% in Headache Index.Low
(unclear risk of bias, imprecision)
MetoprololCephalic vasomotor feedback + stress management175Metoprolol and cephalic vasomotor feedback + stress management had no significant differences in reduction by ≥50% in Headache Index.Low
(unclear risk of bias, imprecision)
Reduction for need for temporary drug therapy for single attacksClonidinePlacebo171Clonidine did not decrease drug utilization for acute migraine attacks.Low
(imprecision)
Improvement in Pediatric Migraine Disability Assessment ScoreTopiramateSodium valproate185Topiramate and sodium valproate had no significant differences in Pediatric Migraine Disability Assessment Score.Low
(unclear risk of bias, imprecision)

RCT = randomized controlled trial

From: Discussion

Cover of Migraine in Children: Preventive Pharmacologic Treatments
Migraine in Children: Preventive Pharmacologic Treatments [Internet].
Comparative Effectiveness Reviews, No. 108.
Shamliyan TA, Kane RL, Ramakrishnan R, et al.

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