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Evidence summaries

Drugs for the Acute Treatment of Migraine in Children and Adolescents

Triptans and sumatriptan plus naproxen sodium are effective at providing pain freedom in children and adolescents with migraine but are associated with higher rates of minor adverse events in adolescents. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 27 studies with a total of 9158 children and adolescents with migraine. A total of 7630 children and adolescents (range of mean age between 8.2 and 14.7 years) received medication. Twenty-four studies focused on drugs in the triptan class. Other medications studied included paracetamol (acetaminophen) and ibuprofen. More than half of the studies evaluated sumatriptan. Triptans as a class of medication were superior to placebo in producing pain freedom in children (RR 1.67, 95% CI 1.06 to 2.62, NNTB 13; 3 studies, n=273) and in adolescents (RR 1.32, 95% CI 1.19 to 1.47, NNTB 6; 21 studies, n=7026). There was no significant difference in the effect sizes between studies involving children vs. adolescents. Triptans were associated with an increased risk of non-serious adverse events in adolescents (RD 0.13, 95% CI 0.08 to 0.18, NNTH 8), but studies did not report any serious adverse events. The risk of minor adverse events was not significant in children (RD 0.06, 95% CI 0.04 to 0.17, NNTH 17). Sumatriptan plus naproxen sodium was superior to placebo in (RR 3.25, 95% CI 1.78 to 5.94, NNTB 6; one study, n= 490). Ibuprofen was more effective than placebo for producing pain freedom at 2 hours (RR 1.87, 95% CI 1.15 to 3.04; 2 studies, n=162). Paracetamol was not superior to placebo (one study, n=80).

Clinical comments

Note

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    References

    • Richer L, Billinghurst L, Linsdell MA et al. Drugs for the acute treatment of migraine in children and adolescents. Cochrane Database Syst Rev 2016;4():CD005220. [PubMed]

Primary/Secondary Keywords