Meta-Analysis Examines Pharmacologic Treatment of Pediatric Headaches


In a meta-analysis, Khalil El-Chammas, M.D., of the Medical College of Wisconsin, Milwaukee, and colleagues reviewed available medical literature to assess the effectiveness of prophylactic headache treatment (to reduce the severity or frequency of headaches) in children and adolescents.


The meta-analysis included 21 trials that were placebo-controlled or comparisons between two or more active medications.


“We conclude that there are limited data suggesting efficacy for trazodone and topiramate in the prophylactic treatment of pediatric episodic migraine headaches. There is no evidence that other commonly used drugs are more effective than placebo, including clonidine, flunarizine, pizotifen, propranolol and valproate, although the paucity of data makes firm conclusions impossible. The few comparative effectiveness trials found only that flunarizine was better than piracetam, with no other differences. There are no trials of chronic migraine or tension headaches, and a single trial among children and adolescents with chronic daily headaches found no benefit from fluoxetine,” the authors conclude. “More studies of pediatric headaches need to be conducted. Because there was a significant placebo response, future trials need to include placebo controls.” (Online First)

(JAMA Pediatr. Published online January 28, 2013. doi:10.1001/jamapediatrics.2013.508.