RT Journal Article
SR Electronic
T1 Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 500
OP 509
DO 10.1212/WNL.0000000000008105
VO 93
IS 11
A1 Oskoui, Maryam
A1 Pringsheim, Tamara
A1 Billinghurst, Lori
A1 Potrebic, Sonja
A1 Gersz, Elaine M.
A1 Gloss, David
A1 Holler-Managan, Yolanda
A1 Leininger, Emily
A1 Licking, Nicole
A1 Mack, Kenneth
A1 Powers, Scott W.
A1 Sowell, Michael
A1 Victorio, M. Cristina
A1 Yonker, Marcy
A1 Zanitsch, Heather
A1 Hershey, Andrew D.
YR 2019
UL http://n.neurology.org/content/93/11/500.abstract
AB Objective To provide updated evidence-based recommendations for migraine prevention using pharmacologic treatment with or without cognitive behavioral therapy in the pediatric population.Methods The authors systematically reviewed literature from January 2003 to August 2017 and developed practice recommendations using the American Academy of Neurology 2011 process, as amended.Results Fifteen Class I–III studies on migraine prevention in children and adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine, or flunarizine are more or less likely than those receiving placebo to have a reduction in headache frequency. Children with migraine receiving propranolol are possibly more likely than those receiving placebo to have an at least 50% reduction in headache frequency. Children and adolescents receiving topiramate and cinnarizine are probably more likely than those receiving placebo to have a decrease in headache frequency. Children with migraine receiving amitriptyline plus cognitive behavioral therapy are more likely than those receiving amitriptyline plus headache education to have a reduction in headache frequency.Recommendations The majority of randomized controlled trials studying the efficacy of preventive medications for pediatric migraine fail to demonstrate superiority to placebo. Recommendations for the prevention of migraine in children include counseling on lifestyle and behavioral factors that influence headache frequency and assessment and management of comorbid disorders associated with headache persistence. Clinicians should engage in shared decision-making with patients and caregivers regarding the use of preventive treatments for migraine, including discussion of the limitations in the evidence to support pharmacologic treatments.AAN=American Academy of Neurology; CBT=cognitive behavioral therapy; CI=confidence interval; DVPX ER=extended-release divalproex sodium; FDA=Food and Drug Administration; PedMIDAS=Pediatric Migraine Disability Assessment; RR=risk ratio; SMD=standardized mean differences