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 Maryam Oskoui
A1 Tamara Pringsheim
A1 Lori Billinghurst
A1 Sonja Potrebic
A1 Elaine M. Gersz
A1 David Gloss
A1 Yolanda Holler-Managan
A1 Emily Leininger
A1 Nicole Licking
A1 Kenneth Mack
A1 Scott W. Powers
A1 Michael Sowell
A1 M. Cristina Victorio
A1 Marcy Yonker
A1 Heather Zanitsch
A1 Andrew D. Hershey
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