Amitriptyline and topiramate no more effective than placebo in paediatric migraine

Researchers found no significant difference in headache response after comparing amitriptyline, topiramate and placebo in 361 children aged 8–17 years.

Amitriptyline tablets

There is currently no comparative evidence available to guide treatment for paediatric migraine and studies suggest the condition is susceptible to strong placebo responses.

To investigate, researchers randomly assigned 361 children aged 8–17 years to amitriptyline, topiramate (two of the most commonly used drugs for paediatric migraine) or placebo for over 24 weeks.

The study ended early following a planned interim analysis. In final analyses, including 328 patients, the researchers found that there was no significant difference between any of the groups in the number of patients having a 50% or greater reduction in headache frequency in the last 28 days of the trial compared with baseline (52% vs 55% vs 61%, respectively).

Reporting in The New England Journal of Medicine
(online, 27 October 2016), the authors say their findings suggest that the adult model of headache treatment may not apply to paediatric patients.


[1] Powers SW, Coffey CS, Chamberlin LA et al. Trial of amitriptyline, topiramate and placebo for pediatric migraine. N Engl J Med 2016; doi: 10.1056/NEJMoa1610384

Last updated
Clinical Pharmacist, CP, December 2016, Vol 8, No 12;8(12):DOI:10.1211/PJ.2016.20201986

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