Document Detail


Pharmacologic treatment of pediatric headaches: a meta-analysis.
MedLine Citation:
PMID:  23358935     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Khalil El-Chammas; Jill Keyes; Nathan Thompson; Jayanthi Vijayakumar; Dorothy Becher; Jeffrey L Jackson
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Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  JAMA pediatrics     Volume:  167     ISSN:  2168-6211     ISO Abbreviation:  JAMA Pediatr     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-05     Completed Date:  2013-04-18     Revised Date:  2013-08-21    
Medline Journal Info:
Nlm Unique ID:  101589544     Medline TA:  JAMA Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  250-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Medical College of Wisconsin, 5000 W National Ave, Milwaukee, WI 53295, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenergic beta-Antagonists / therapeutic use
Analgesics / therapeutic use*
Anticonvulsants / therapeutic use
Child
Child, Preschool
Comparative Effectiveness Research
Fructose / analogs & derivatives,  therapeutic use
Headache / drug therapy*
Headache Disorders / drug therapy*
Humans
Migraine Disorders / drug therapy*
Placebo Effect
Serotonin Uptake Inhibitors / therapeutic use
Trazodone / therapeutic use
Grant Support
ID/Acronym/Agency:
UL1 TR000055/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Analgesics; 0/Anticonvulsants; 0/Serotonin Uptake Inhibitors; 0H73WJJ391/topiramate; 19794-93-5/Trazodone; 30237-26-4/Fructose
Comments/Corrections
Comment In:
JAMA Pediatr. 2013 Mar 1;167(3):300-2   [PMID:  23358915 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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