Author, Year

Class

Drug:

Efficacy

Hamalainen, et al., 1997 (18)

I

Ibuprofen

Active: 68%

Placebo: 37%

P-value: <.05*

Lewis, et al., 2002 (19)

I

Ibuprofen

Active: 76%

Placebo: 53%

P-value: .006

Hamalainen, et al., 1997 (18)

I

 Acetaminophen

Active: 54%

Placebo: 37%

Exact p-values not provided <.05

Ueberall, 1999 (20)

I

Sumatriptan, Nasal

Active: 85.7%

Placebo: 42.8%

P-value: .03

Winner, et al., 2000 (21)

I

Sumatriptan, Nasal

Active: 66%

Placebo: 53%

Exact p-values not provided (~.05)

Ahonen, et al., 2004 (22)

I

Sumatriptan, Nasal

Active: 64%

Placebo: 39%

P-value: .003

Hamalainen, et

al., 1997(25)

I

Sumatriptan, Oral

Active: 30%

Placebo: 22%

P-value: non-significant

Winner, et al.,

2002 (26)

I

Oral Triptans,

Rizatriptan

Active: 66%

Placebo: 56%

P-value: non-significant

 

          For the acute treatment of migraine headaches in children, both ibuprofen and acetaminophen have been shown to be safe and effective.

 

          Sumatriptan is the only 5HT1 agonist that has proven effective for the treatment of children and adolescents with migraine with the nasal spray having the most favorable profile.

 

          There is only class IV evidence for effectiveness of subcutaneous sumatriptan. Oral triptan agents have not demonstrated efficacy in class I studies.

 

          Ibuprofen is effective and should be considered for the acute treatment of migraine in children. (Class I, Level A)

 

          Acetaminophen is probably effective and should be considered for the acute treatment of migraine in children. (Class I, Level B)

 

          Sumatriptan nasal spray is effective and should be considered for the acute treatment of migraine in adolescents. (Class I, Level A)

 

          There is no supporting data for the use of any oral triptan preparations in children or adolescents. (Class IV, Level U)

 

          There is inadequate data to make a judgement on the efficacy of subcutaneous sumatriptan. (Class IV, Level U)

 

Author,

Year

Class

Drug (Antidepressants and Calcium Channel blockers)

Efficacy

Gillies, et al., 1986 (36)

I

Antidepressant medications, Pizotifen

Non-significant

Battostella, et

al., 1993(35)

II

Antidepressant medications, Trazodone

Non-significant

Sorge, et al., 1988 (42)

I

Calcium channel blockers, Flunarizine

p<0.001, 75% had 75-100% reduction headache frequency

Battistella, et

al 1990(41)

I

Calcium channel blockers, Nimodipine

Non-significant

Ludvigsson,

1974 (29)

II

Propranolol

81%

Forsythe, et

al., 1984 (30)

II

Propranolol

Non-significant

Olness, et al., 1987 (31)

II

Propranolol

Non-significant

Sills, et al., 1982 (32)

II

Clonidine

Non-significant

Sillanpaa, 1977 (33)

II

Clonidine

Active: 32%

Placebo: 34%

P-value: Non-significant

 

          Flunarizine was studied in one class I trial and is probably effective but is unavailable in the US.

 

          The evidence is insufficient to determine efficacy for the antihistamine cyproheptadine, the antidepressant amitriptyline, and the anticonvulsant agents valproic acid, topiramate, and levetiracetam for prevention of pediatric migraine.

 

          There is conflicting class II evidence regarding propranolol and trazodone. Clonidine, pizotifen, nimodipine and timolol were not shown to be more effective than placebo.

 

          Flunarizine is probably effective for preventive therapy and can be considered for this purpose but it is not available in the United States. (Class I, Level B)

 

          There is insufficient evidence to make any recommendations concerning the use of: (Class IV, Level U)

         Cyproheptadine

         Amitriptyline

         Divalproex sodium

         Topiramate

         Levetiracetam.

 

          Recommendations cannot be made concerning propranalol or trazodone for preventive therapy as the evidence is conflicting. (Class II, level U)

 

          Pizotifen and nimodipine (Class I, Level B) and clonidine and timolol (Class II, Level B) did not show efficacy and are not recommended.