|
Author, Year |
Class |
Drug: |
Efficacy |
|
Hamalainen, et al., 1997 (18) |
I |
Ibuprofen |
Active: 68% Placebo: 37% P-value: <.05* |
|
Lewis, et al., 2002 (19) |
I |
Ibuprofen |
Active: 76% Placebo: 53% P-value: .006 |
|
Hamalainen, et al., 1997 (18) |
I |
Acetaminophen |
Active: 54% Placebo: 37% Exact p-values not provided <.05 |
|
Ueberall, 1999 (20) |
I |
Sumatriptan, Nasal |
Active: 85.7% Placebo: 42.8% P-value: .03 |
|
Winner, et al., 2000 (21) |
I |
Sumatriptan, Nasal |
Active: 66% Placebo: 53% Exact p-values not provided (~.05) |
|
Ahonen, et al., 2004 (22) |
I |
Sumatriptan, Nasal |
Active: 64% Placebo: 39% P-value: .003 |
|
Hamalainen, et al., 1997(25) |
I |
Sumatriptan, Oral |
Active: 30% Placebo: 22% P-value: non-significant |
|
Winner, et al., 2002 (26) |
I |
Oral Triptans, Rizatriptan |
Active: 66% Placebo: 56% P-value: non-significant |
•
For the acute treatment of migraine headaches in
children, both ibuprofen and acetaminophen have been shown to be safe and
effective.
•
Sumatriptan is the only 5HT1
agonist that has proven effective for the treatment of children and adolescents
with migraine with the nasal spray having the most favorable profile.
•
There is only class IV evidence for effectiveness of
subcutaneous sumatriptan. Oral “triptan”
agents have not demonstrated efficacy in class I studies.
•
Ibuprofen is effective and should be considered for
the acute treatment of migraine in children. (Class I, Level A)
•
Acetaminophen is probably effective and should be
considered for the acute treatment of migraine in children. (Class I,
Level B)
•
Sumatriptan nasal spray is
effective and should be considered for the acute treatment of migraine in
adolescents. (Class I, Level A)
•
There is no supporting data for the use of any oral “triptan” preparations in children or adolescents. (Class
IV, Level U)
•
There is inadequate data to make a judgement
on the efficacy of subcutaneous sumatriptan. (Class
IV, Level U)
|
Author, Year |
Class |
Drug (Antidepressants and Calcium Channel blockers) |
Efficacy |
|
Gillies, et al., 1986 (36) |
I |
Antidepressant medications, Pizotifen |
Non-significant |
|
Battostella, et al., 1993(35) |
II |
Antidepressant medications, Trazodone |
Non-significant |
|
Sorge, et al., 1988 (42) |
I |
Calcium channel blockers, Flunarizine |
p<0.001, 75% had 75-100% reduction headache frequency |
|
Battistella, et al 1990(41) |
I |
Calcium channel blockers, Nimodipine |
Non-significant |
|
Ludvigsson, 1974 (29) |
II |
Propranolol |
81% |
|
Forsythe, et al., 1984 (30) |
II |
Propranolol |
Non-significant |
|
Olness, et al., 1987 (31) |
II |
Propranolol |
Non-significant |
|
Sills, et al., 1982 (32) |
II |
Clonidine |
Non-significant |
|
Sillanpaa, 1977 (33) |
II |
Clonidine |
Active: 32% Placebo: 34% P-value: Non-significant |
•
Flunarizine was studied in one
class I trial and is probably effective but is unavailable in the
•
The evidence is insufficient to determine efficacy for
the antihistamine cyproheptadine, the antidepressant amitriptyline, and the anticonvulsant agents
valproic acid, topiramate,
and levetiracetam for prevention of pediatric
migraine.
•
There is conflicting class II evidence regarding propranolol and trazodone. Clonidine, pizotifen, nimodipine and timolol were not
shown to be more effective than placebo.
•
Flunarizine is probably
effective for preventive therapy and can be considered for this purpose but it
is not available in the
•
There is insufficient evidence to make any
recommendations concerning the use of: (Class IV, Level U)
–
Cyproheptadine
–
Amitriptyline
–
Divalproex sodium
–
Topiramate
–
Levetiracetam.
•
Recommendations cannot be made concerning propranalol or trazodone for
preventive therapy as the evidence is conflicting. (Class II, level U)
•
Pizotifen and nimodipine (Class I, Level B) and clonidine and timolol (Class
II, Level B) did not show efficacy and are not recommended.