JAMA Netw Open

Which preventive medications are most effective for pediatric migraine?

October 17, 2024

Topiramate and pregabalin were found to reduce headache frequency and intensity in pediatric migraine patients. Although other drugs like flunarizine, riboflavin, amitriptyline, and cinnarizine showed statistically significant results, no drugs improved quality of life or attack duration, highlighting the need for further research and potential combination therapies.

This network meta-analysis included 45 randomized trials with 3,771 participants. Primary outcome was migraine frequency per month; secondary outcomes included a ≥50% responder rate, headache duration, intensity, and disability.

Findings

• Pregabalin and topiramate with vitamin D3 were associated with reduction in migraine frequency, compared with placebo.
• Flunarizine, levetiracetam, riboflavin, cinnarizine, topiramate, and amitriptyline were also associated with reduced migraine frequency, but findings were taken from individual studies.
• For the ≥50% responder rate, flunarizine and α-lipoic acid, flunarizine, pregabalin, and cinnarizine were associated with significantly greater effectiveness than placebo.
• Propranolol and cinnarizine, pregabalin, valproate, levetiracetam, and cinnarizine were significantly associated with reduction in headache intensity, compared with placebo.
• Adverse events were increased with amitriptyline, topiramate, and valproate, compared with placebo.

Source:

Kohandel Gargari O, et al. (2024, October 1). JAMA Netw Open. Preventive Medications in Pediatric Migraine: A Network Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/39388181/