Little evidence to inform pharmacological paediatric migraine prevention, review finds

There is limited evidence available to support the efficacy of pharmacological treatments in the prevention of paediatric migraines, a systematic review has concluded^[1]
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The researchers looked at 23 randomised controlled trials, involving 2,217 paediatric and adolescent patients with episodic migraine, and studied the efficacy of prophylactic pharmacologic treatments including antiepileptics, antidepressants, beta blockers, calcium channel blockers, antihypertensive agents and food supplements.

Network meta-analysis found that, in the short term, two treatments — the beta-blocker propranolol and antiepileptic topiramate — had a significant impact on symptoms, such as migraine frequency and number of headache days, compared with placebo (standardised mean difference: 0.60; 95% Confidence Interval [CI], 0.03-1.17 and 0.59; 95% CI, 0.03-1.15, respectively). However, the researchers noted a lack of evidence for long-term treatment in any of the included studies.

Writing in JAMA Pediatrics (10 February 2020), the team said that prophylactic treatment should be very carefully prescribed in children, weighing the benefits against potential harms. They also suggested that the placebo effect could be particularly strong in children and adolescents, compared with adults, which could explain the findings.

“Further studies are needed to determine the best treatment for the prophylaxis of paediatric migraine, especially those that directly compare medicines and psychologic treatments,” they wrote.

“Trials are needed that allow to quantify the placebo effect in paediatric migraine.”