Maryam Oskoui1, Tamara Pringsheim1, Lori Billinghurst1, Sonja Potrebic1, Elaine M Gersz1, David Gloss1, Yolanda Holler-Managan1, Emily Leininger1, Nicole Licking1, Kenneth Mack1, Scott W Powers1, Michael Sowell1, M Cristina Victorio1, Marcy Yonker1, Heather Zanitsch1, Andrew D Hershey1. 1. From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO.
Abstract
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.
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.
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