A recent network meta-analysis indicates that topiramate and pregabalin are effective in reducing headache frequency and intensity in children and adolescents experiencing migraines. The study, led by Omid Kohandel Gargari, MD, from the Iranian Center of Neurological Research, highlights the potential of these drugs, along with others, in managing pediatric migraine, a condition affecting approximately 11% of children and adolescents.
The meta-analysis, conducted between December 2023 and March 2024, assessed the efficacy, safety, and acceptability of various oral pharmacological interventions for pediatric migraine prophylaxis. Researchers analyzed data from 45 randomized clinical trials, encompassing 3771 pediatric patients, sourced from PubMed, Embase, and SCOPUS up to September 2023. The primary outcome was migraine frequency, while secondary outcomes included response rate (≥ 50% reduction), headache duration and intensity, disability, and adverse events.
The findings revealed that pregabalin (RoM, 0.38; 95% CI, 0.18 – 0.79) and topiramate with vitamin D3 (RoM, 0.44; 95% CI, 0.30 – 0.65) were significantly associated with reduced migraine frequency compared to placebo. Notably, pregabalin alone reduced migraine frequency by 63%, with the addition of vitamin D supplementation increasing this reduction to 88%.
Other medications, including flunarizine (RoM, 0.46; 95% CI, 0.26 – 0.81), levetiracetam (RoM, 0.47; 95% CI, 0.30 – 0.72), riboflavin (RoM, 0.50; 95% CI, 0.32 – 0.77), cinnarizine (RoM, 0.64; 95% CI, 0.46 – 0.88), topiramate (RoM, 0.70; 95% CI, 0.55 – 0.89), and amitriptyline (RoM, 0.73; 95% CI, 0.54 – 0.97), also demonstrated a reduction in migraine frequency, although these results were based on separate studies.
Response Rate and Adverse Events
Several drugs showed a ≥ 50% response rate, indicating greater effectiveness than placebo. These included flunarizine and α-lipoic acid (RR, 8.73; 95% CI, 2.44 – 31.20), flunarizine (RR, 4.00; 95% CI, 1.38 – 11.55), pregabalin (RR, 1.88; 95% CI, 1.13 – 3.14), and cinnarizine (RR, 1.46; 95% CI, 1.04 – 2.05).
However, the study also identified treatments associated with significant adverse events. Amitriptyline (RR, 3.81; 95% CI, 1.41 – 10.32), topiramate (RR, 4.34; 95% CI, 1.60 – 11.75), and valproate (RR, 5.93; 95% CI, 1.93 – 18.23) had the greatest incidence of adverse events compared to placebo.
Implications for Pediatric Migraine Management
The researchers emphasized the potential benefits of combination therapies, particularly those involving vitamin supplementation, and called for larger, randomized clinical trials to validate these findings and explore new strategies for enhancing care in pediatric migraine management. The study also noted that no pharmacological interventions significantly improved quality of life or reduced migraine attack duration, highlighting the complexity of treating pediatric migraine and the need for further research into alternative treatment options.
