By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD
There’s very little evidence that any migraine-prevention medication is effective in children, according to a network meta-analysis in JAMA Pediatrics.
Researchers examined data from 23 randomized trials that compared different migraine-prevention medications with each other or with placebo in roughly 2200 children or adolescents with episodic migraine. The most frequently studied medications included propranolol, topiramate, riboflavin, valproate sodium, and cinnarizine.
Only propranolol and topiramate showed a significant effect relative to placebo, but, the researchers note, “the 95% prediction interval for both … which reflects the variation in true treatment effects over different settings … was nonsignificant.”
An editorialist advises the following to migraine experts who recommend pharmacologic prophylaxis in children. “Reconsider recommendations and rewrite your guidelines.” And to pediatric clinicians, he says: “Do not use pharmacological prophylactic treatment regularly in your daily practice.” He adds: “Because the placebo effect is heightened in children and the proof of a true pharmacological association is weak, use nonpharmacological approaches.”