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New Developments in the Prophylactic Drug Treatment of Pediatric Migraine: What Is New in 2017 and Where Does It Leave Us?

  • Joanne KacperskiEmail author
  • Allyson BazarskyEmail author
Childhood and Adolescent Headache (S Evers, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Childhood and Adolescent Headache

Abstract

Purpose of Review

Headaches in children are quite common; however, the study and characterization of headache disorders in the pediatric age group has historically been limited. Because of the lack of controlled studies on prophylactic treatment of headache disorders in this age group, the diagnosis of migraine rests on criteria similar those in adults. Likewise, data from adult studies is often inferred and applied to children. Although it appears that many preventives are safe in children, currently none are FDA or EMA approved for this age group. Consequently, many children who present to their primary care physicians with migraines do not receive any preventive therapy despite experiencing significant disability.

Recent Findings

Controlled clinical trials investigating the use of preventive medications in children have suffered from high placebo response rates. The shorter duration of headaches and other characteristic features seen in children are such that designing randomized controlled trials in this age group is more problematic and limiting. Treatment practices vary widely, even among specialists, due to the absence of evidence-based guidelines from clinical trials. The Childhood and Adolescent Migraine Prevention Study (CHAMP) was developed to examine the effectiveness of two of the most widely prescribed preventive medications for pediatric migraine and help narrow this gap. To date, it has been the largest enrolling study of its kind within the pediatric migraine world; its results and implications will be discussed and considered here.

Summary

The CHAMP trial was discontinued early on account of futility and exhibited that neither of two preventive medications for pediatric migraine was more effective than placebo in reducing the number of headache days over a period of 24 weeks. Subjects in the amitriptyline and topiramate groups had higher rates of adverse events than those who had received placebo.

Keywords

Migraine Pediatric migraine Preventive headache treatment Prophylactic headache treatment Nonpharmacologic treatment CHAMP: Childhood and adolescent migraine prevention study 

Notes

Compliance with Ethical Standards

Conflict of Interest

Joanne Kacperski and Allyson Bazarsky declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Division of NeurologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of Pediatrics, College of MedicineUniversity of CincinnatiCincinnatiUSA

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