Migraine headache in children.

INTRODUCTION: Diagnosis of migraine headache in children can be difficult as it depends on subjective symptoms; diagnostic criteria are broader than in adults. Migraine occurs in 3% to 10% of children and increases with age up to puberty. Migraine spontaneously remits after puberty in half of children, but if it begins during adolescence it may be more likely to persist throughout adulthood. METHODS AND OUT- COMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for acute attacks of migraine headache in children? What are the effects of pharmacological prophylaxis for migraine headache in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2014 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: Twenty-three studies were included. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions. For acute symptom relief: 5HT1 agonists [such as triptans], non-steroidal anti-inflammatory drugs [NSAIDs], and paracetamol. And, for prophy- laxis: beta-blockers, flunarizine, pizotifen, and topiramate. dose, although it did not report the overall results. The RCT reported no significant differences between any dose of almotriptan and placebo in the proportion of participants with nausea (participants aged 15–17 years; nausea: 14.8% with almotriptan 6.25 mg v 18.8% with 12.5 mg v 18.4% with 25 mg v 15.2% with placebo; participants aged 12–14 years: 13% with almotriptan 6.25 mg v 15% with 12.5 mg v 23% with 25 mg v 16% with placebo; P values not reported; reported as not significant). almotriptan 12.5 mg significantly decreased photophobia mg 6.25 almotriptan profiles confounded apparent treatment effects in this study. All three crossover RCTs included in the meta-analysis reported pre-crossover results. study for symptomatic relief of moderate to severe headache attacks paracetamol follow-up: 14.22 in the propranolol group 7.48 topiramate ibuprofen follow-up: 8.34 propranolol v 3.26 topiramate The crossover RCT was also reported to have clear crossover effect; thus, the review only reported the pre-crossover results (up to 3 months). The crossover RCT found that headache frequency (number of attacks per month) was significantly lower with flunarizine versus placebo after 2 and 3 months of treatment (P <0.001 for both time points), but there was no statistically significant difference between the two interventions at 1 month. The crossover RCT also found headache duration (number of hours per attack) was significantly lower with flunarizine versus placebo after 2 months (P <0.01) and 3 months (P <0.001) of treatment, but there was no statistically significant difference between the two interventions at 1 month.