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2013 ; 167
(3
): 250-8
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Pharmacologic treatment of pediatric headaches: a meta-analysis
#MMPMID23358935
El-Chammas K
; Keyes J
; Thompson N
; Vijayakumar J
; Becher D
; Jackson JL
JAMA Pediatr
2013[Mar]; 167
(3
): 250-8
PMID23358935
show ga
OBJECTIVE To assess the effectiveness of prophylactic headache treatment in
children and adolescents. DATA SOURCES PubMed, EMBASE, Cochrane Database of
Clinical Trials, and bibliography of retrieved articles through August 11, 2012.
STUDY SELECTION Randomized trials of headache treatment among children and
adolescents (<18 years old). INTERVENTION Any placebo-controlled trial or
comparisons between 2 or more active medications. MAIN OUTCOME MEASURE Number of
headaches per month. RESULTS Among 21 included trials, there were 13
placebo-controlled and 10 active comparator trials (2 also included placebo).
Twenty trials focused on episodic migraines and 1 on chronic daily headaches.
Drugs more effective than placebo for episodic migraines (<15 headaches per
month) included topiramate (difference in headaches per month, -0.71; 95% CI,
-1.19 to -0.24) and trazodone (-0.60; 95% CI, -1.09 to -0.11). Ineffective drugs
included clonidine, flunarizine, pizotifen, propranolol, and valproate. A single
trial of fluoxetine for chronic daily headaches found it ineffective. Patients
given placebo experienced a significant (P = .03) decline in headaches, from 5.6
(95% CI, 4.52-6.77; Q = 8.14 [Cochran Q is a measure of the heterogeneity of the
included studies]) to 2.9 headaches per month (95% CI, 1.66-4.08; Q = 4.72).
Among the 10 active comparator trials, flunarizine was more effective than
piracetam (difference in headaches per month, -2.20; 95% CI, -3.93 to -0.47) but
no better than aspirin, dihydroergotamine, or propranolol. Propranolol was
compared with valproate as well as behavioral treatment, and 2 studies compared
different doses of topiramate; none of these trials showed significant
differences. CONCLUSIONS Topiramate and trazodone have limited evidence
supporting efficacy for episodic migraines. Placebo was effective in reducing
headaches. Other commonly used drugs have no evidence supporting their use in
children and adolescents. More research is needed.
|Adolescent
[MESH]
|Adrenergic beta-Antagonists/therapeutic use
[MESH]
|Analgesics/*therapeutic use
[MESH]
|Anticonvulsants/therapeutic use
[MESH]
|Child
[MESH]
|Child, Preschool
[MESH]
|Comparative Effectiveness Research
[MESH]
|Fructose/analogs & derivatives/therapeutic use
[MESH]
|Headache Disorders/*drug therapy
[MESH]
|Headache/*drug therapy
[MESH]
|Humans
[MESH]
|Migraine Disorders/*drug therapy
[MESH]
|Placebo Effect
[MESH]
|Selective Serotonin Reuptake Inhibitors/therapeutic use
[MESH]
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