Introduction
(1) Migraine without aura |
(2) Migraine with aura |
a. Typical aura with migraine headache |
b. Typical aura with non-migraine headache |
c. Typical aura without headache |
d. Familial hemiplegic migraine |
e. Sporadic hemiplegic migraine |
f. Basilar-type migraine |
(3) Childhood periodic syndromes that are commonly precursors of migraine |
a. Cyclic vomiting |
b. Abdominal migraine |
c. Benign paroxysmal vertigo of childhood |
(4) Retinal migraine |
(5) Complications of migraine |
(6) Probable migraine |
Level A: two or more clinically controlled, randomized studies carried out according to good clinical practice (GCP), versus placebo or versus active treatment of proven efficacy |
Level B: one clinically controlled, randomized study carried out according to GCP or more than one well-designed clinical case–control study or cohort study |
Level C: favorable judgment of two-third of the Ad Hoc Committee members, historical controls, non-randomized studies, case reports |
Literature search strategy
Pediatric migraine treatment: general approach
Acute treatments of migraine
Analgesics
Triptans
Sumatriptan
Drug | Evidence level | Study design | Ages (years) |
n
| Primary end point: pain relief (hours) | Responders (%) | Placebo responses (%) | P value | Author/Pubdate/Ref. |
---|---|---|---|---|---|---|---|---|---|
Ibuprofen | |||||||||
10 mg/kg | A | rDBPC | 4–16 | 88 | 2 | 68 | 37 | <0.05 | |
7.5 mg/kg | DBPC | 6–12 | 84 | 2 | 76 | 53 | 0.006 | ||
200–400 mg | DBPCCO | 6–18 | 32 | 2 | 69 | 28 | <0.05 | Evers et al., 2006 [21] | |
Acetaminophen | |||||||||
15 mg/kg | B | rDBPC | 4–16 | 88 | 2 | 54 | 37 | <0.05 | |
Sumatriptan nasal | |||||||||
20 mg | A | rDBPC | 6–10 | 14 | 2 | 86 | 42.8 | 0.03 | Ueberall et al., 1999 [18] |
5–10–20 mg | rDBPC | 12–17 | 510 | 2 | 63–66 | 53 | <0.05 | Winner et al., 2000 [18] | |
10–20 mg | rDBPCCO | 8–17 | 83 | 2 | 64 | 39 | 0.003 | Ahonen et al., 2004 [18] | |
20 mg | rDBPC | 12–17 | 738 | 1 | 61 | 52 | ns | Winner et al., 2006 [19] | |
Sumatriptan oral | |||||||||
50–100 mg | C | rDBPCCO | 8–16 | 23 | 2 | 30 | 22 | ns | |
Sumatriptan subcutaneous | |||||||||
3–6 mg | C | OL | 6–16 | 17 | 2 | 64 | – | – | |
0.06 mg/kg | OL | 6–18 | 50 | 2 | 78 | – | – | ||
Zolmitriptan oral | |||||||||
2.5–5 mg | C | OL | 12–17 | 38 | 2 | 88 | – | – | |
2.5 mg | DBPCCO | 6–18 | 32 | 2 | 62 | 28 | P < 0.05 | Evers et al., 2006 [21] | |
2.5–5–10 mg | rDBPC | 12–17 | 850 | 2 | 53–57 | 58 | ns | Rothner et al., 2006 [20] | |
Zolmitriptan NS | |||||||||
5 mg | B | SB-DBPC | 12–17 | 171 | 1 | 58.1 | 43.3 | P < 0.05 | Lewis et al., 2007 [22] |
Rizatriptan oral | |||||||||
5 mg | C | rDBPC | 12–17 | 296 | 2 | 66 | 56 | ns | |
5 mg | rDBPC | 12–17 | 234 | 2 | 68.2 | 68.8 | ns | Visser et al., 2004 [23] | |
5 mg | OL | 12–17 | 686 | 2 | 77 | – | – | Visser et al., 2004 [23] | |
5–10 mg | rDBPC | 6–17 | 96 | 2 | 74 | 36 | P = 0.001 | Ahonen et al., 2006 [24] | |
Almotriptan oral | |||||||||
6.25–12.5 mg | B | OL | 11–17 | 15 | 2 | 85 | – | – | Charles et al., 2006 [25] |
6.25–12.5–25 mg | rDBPC | 12–17 | 866 | 2 | 67–73 | 55 | P < 0.001 | Linder et al., 2008 [26] | |
Eletriptan oral | |||||||||
40 mg | C | DBPC | 12–17 | 267 | 2 | 57 | 57 | ns | Winner et al., 2007 [27] |
Naratriptan oral | C | DBPC | 12–17 | 300 | 4 | 64–72 | 65 | ns |
Zolmitriptan
Rizatriptan
Almotriptan
Eletriptan
Antiemetics
Prophylactic treatment of pediatric migraine
Calcium channel blockers
Antidepressants
Amitriptyline
Antiepileptic drugs
Topiramate
Drug | Evidence level | Study design | Ages (years) |
n
| Drug response rate (%) | Placebo response rate (%) | P value (primary endpoint) | Reference |
---|---|---|---|---|---|---|---|---|
Flunarizine | ||||||||
5 mg | A | DBPC | 7–14 | 42 | 76 | 19 | P < 0.001 (freq and durat) | |
5 mg | OL | 10–13 | 12 | 66 | – | – | ||
5 mg | DBPC CO | 5–11 | 63 | 67 | 33 | P < 0.001 (freq) P < 0.01 (durat) | ||
Nimodipine | ||||||||
10–20 mg | C | DBPCCO | 7–18 | 37 | 15 | 15 | ns (freq) | |
Propanolol | ||||||||
60–120 mg | C | DBCO | 7–16 | 28 | 82 | 14 | P < 0.001 (freq) | |
80 mg | DBPC | 3–12 | 39 | 58 | 55 | ns | ||
3 mg/kg | DBPC | 6–12 | 28 | ns | ns | ns | ||
Timolol | C | DBPC CO | 6–13 | 19 | 38 | 40 | ns | |
Clonidine | ||||||||
25–50 μg | C | DBPC | <15 | 57 | 32 | 34 | ns | |
0.07–0.1 mg | DBPC | 7–14 | 43 | ns | ns | ns | ||
Cyproheptadine | ||||||||
4 mg | C | RR | 3–12 | 30 | 83 | – | – | Lewis et al., 2004 [32] |
Amitriptyline | ||||||||
1 mg/kg | C | OL | 9–15 | 192 | 84 | – | – | |
10 mg | RR | 3–18 | 73 | 89 | – | – | Lewis et al., 2004 [32] | |
Trazodone | ||||||||
1 mg/(kg day) | C | DBPC | 7–18 | 35 | 45 | 40 | ns | |
Pizotifen | C | DBPC CO | 7–14 | 47 | 15 | 16 | ns | |
Topiramate | ||||||||
12.5–225 mg | A | OL | 8–15 | 75 | 43–59 | – | P < 0.001 (freq) | |
2–3 mg/kg | rDBPC | 6–15 | 162 | 54.6 | 46.9 | ns | Winner et al., 2005 [35] | |
50, 100, 200 mg | DBPC | 12–17 | 51 | 46–65 | 16 | P = 0.02 (100 mg), P = 0.04 (200 mg) (freq) | Winner et al., 2006 [38] | |
100 mg | DBPC | 8–14 | 44 | 95 | 52 | P = 0.02 (freq) | Lakshmi et al., 2007 [36] | |
100 mg | rDBPC | 12–17 | 85 | 83 | 45 | P < 0.001 (freq) | Lewis et al., 2009 [37] | |
50–200 mg | RR | 7–20 | 37 | 76 | – | P < 0.001 (freq) | Cruz et al., 2009 [39] | |
Valproate | ||||||||
15–45 mg/(kg day) | B | OL | 7–16 | 42 | 78.5 | – | P < 0.05 (freq) | |
500–1,000 mg/day | OL | 9–17 | 10 | 83 | – | P = 0.002 (freq) | ||
250–1,125 mg/day | OL | 7–17 | 23 | 65 | – | P < 0.05 (freq) | ||
10–40 mg/(kg day) | rDBPC | 3–15 | 58 | 72 | – | P < 0.05 (freq) | Ashrafi et al., 2005 [40] | |
250, 500, 1,000 mg | rDBPC | 12–17 | 300 | 36–51 | 46 | ns | Apostol et al., 2008 [41] | |
500–1,000 mg | OL | 12–17 | 241 | – | – | >75% (freq) | Apostol et al., 2009 [42] | |
Levetiracetam | B | OL | 19 | 3–17 | 52 | – | P < 0.001 (freq) | |
250–1,500 mg | OL | 20 | 6–17 | 90 | – | P < 0.001 (freq) | Pekalnis et al., 2007 [44] | |
Gabapentin | ||||||||
15 mg/kg | C | RR | 18 | 6–17 | 83 | – | P < 0.001 (freq) | |
Zonisamide | ||||||||
5.8 mg/kg | C | OL | 12 | 10–17 | 66 | – | – | Pakalnis et al., 2006 [45] |