Neuropediatrics 2006; 37 - PS2_3_3
DOI: 10.1055/s-2006-945573

DRUG THERAPY FOR MIGRAINE IN CHILDREN: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

L Richer 1, L Billinghurst 1, K Russel 1, B Vandermeer 1, E Crumley 1, TP Klassen 1, L Hartling 1
  • 1University of Alberta, Edmonton, AB, Canada

Objectives: To systematically review all randomized controlled trials that examine abortive drug therapy for migraine in children between 3 and 18 years of age.

Methods: Six electronic bibliographic databases were searched. Trials were included if they examined children with acute migraine and compared a drug to placebo, another drug, or standard care. Inclusion criteria were applied and methodological quality was assessed independently by two reviewers. Data were extracted using a structured form. Standard meta-analytic methods were used to combine study results.

Results: Sixteen studies were included; few compared the same drugs. The most frequently studied class of drugs was the triptans (n=12); seven of these compared sumatriptan to placebo. Overall, the triptans showed mild benefit over placebo with respect to headache alleviation (RR 1.13; 95% CI 1.06, 1.20) and complete headache relief (RR 1.34; 95% CI 1.18, 1.52). Although the triptans resulted in more adverse events compared to placebo (RD 0.15; 95% CI 0.07, 0.23), in all cases these were minor. There was evidence of publication bias suggesting that the observed effects may be overestimates. Subgroup analyses showed some variation in efficacy by age, study design, and methodological quality. Headache alleviation and complete headache relief were significantly improved for ibuprofen vs. placebo (n=2), prochlorperazine vs. ketorolac (n=1), and rizatriptan vs. standard care (n=1); ibuprofen significantly reduced headache recurrence compared to placebo (n=2). There were no significant differences for acetaminophen vs. placebo (n=1), dihydroergotamine vs. placebo (n=1), or acetaminophen vs. ibuprofen (n=1). Placebo response rates varied greatly from study to study causing some heterogeneity in the estimates.

Conclusion: Triptans, ibuprofen, and prochlorperazine may be somewhat effective as abortive therapy for migraines in children. There is a paucity of evidence for other medications.