Maryam Oskoui1, Tamara Pringsheim2, Lori Billinghurst3, Sonja Potrebic4, Elaine M Gersz5, David Gloss6, Yolanda Holler-Managan7, Emily Leininger8, Nicole Licking9, Kenneth Mack10, Scott W Powers11, Michael Sowell12, M Cristina Victorio13, Marcy Yonker14, Heather Zanitsch15, Andrew D Hershey11. 1. Departments of Pediatric and Neurology/Neurosurgery, McGill University, Montréal, Quebec, Canada. 2. Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada. 3. Division of Neurology, Children's Hospital of Philadelphia, PA. 4. Neurology Department, Southern California Permanente Medical Group, Kaiser, Los Angeles. 5. Rochester, NY. 6. Department of Neurology, Charleston Area Medical Center, Charleston, WV. 7. Department of Pediatrics (Neurology), Northwestern University Feinberg School of Medicine, Chicago, IL. 8. St. Paul, MN. 9. Department of Neuroscience and Spine, St. Anthony Hospital-Centura Health, Lakewood, CO. 10. Department of Neurology, Mayo Clinic, Rochester, MN. 11. Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, OH. 12. University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program, KY. 13. Division of Neurology, NeuroDevelopmental Science Center, Akron Children's Hospital, OH. 14. Division of Neurology, Children's Hospital Colorado, Aurora. 15. O'Fallon, 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 in adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine and 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 in adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine and 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.
Authors: Kaitlin A Greene; Carlyn P Gentile; Christina L Szperka; Marcy Yonker; Amy A Gelfand; Barbara Grimes; Samantha L Irwin Journal: Pediatr Neurol Date: 2020-10-05 Impact factor: 3.372
Authors: Amy A Gelfand; Sara Pavitt; Alexandra C Ross; Christina L Szperka; Samantha L Irwin; Suzanne Bertisch; Katie L Stone; Remi Frazier; Barbara Grimes; I Elaine Allen Journal: Headache Date: 2020-11-25 Impact factor: 5.887