First-line migraine prophylaxis includes pharmacologic treatments, including antiepileptics, antidepressants, calcium channel blockers, antihypertensive agents, and food supplements. However, whether pharmacologic treatments are more effective in children and adolescents is not clear. This study aims to evaluate the efficacy, safety, and acceptability of pharmacologic treatments for pediatric migraine prophylaxis.
This systematic review and network meta-analysis included 23 randomized clinical trials of prophylactic pharmacologic treatments in 2,217 children and adolescents with episodic migraine. The efficacy of the treatments was analyzed using migraine and headache frequency. The safety and acceptability were assessed by treatment discontinuation due to adverse events. The primary outcomes of the study were safety, efficacy, and acceptability of the prophylactic pharmacologic treatments.
The primary outcomes of the following treatments were analyzed: antiepileptics, antidepressants, calcium channel blockers, antihypertensive agents, and food supplements. In the short term, topiramate and propranolol were found to be more effective than a placebo. However, the majority of prediction intervals for these treatments resulted in a null effect. The researchers found no significant long-term benefits fo migraine prophylaxis relative to placebo.
The research concluded that prophylactic pharmacologic treatments, including topiramate and propranolol, showed positive outcomes for pediatric migraines, but the evidence supporting their superiority is very limited.