P29 The preventative management of migraine headaches in paediatrics
Authors: Martin Judith 
Published: August 2020

Aim

To determine the optimal preventative treatment option for paediatric migraine

Design

A retrospective method. A review of 100 paediatric patients who attended outpatient clinics and their clinical outcomes evaluated at day 0, and at their next outpatient appointment (which is approximately 3 months after their first review). Their treatment was analysed to determine if they have remained on their migraine prophylaxis or changed to a different option.

Setting

Children outpatient setting in a District General Hospital.

Participants

100 paediatric patients aged below 18 years of age.

Intervention

Patients aged below 18 years of age who have a documented diagnosis of migraine. This excluded abdominal migraine.

Main Outcome Measures

To identify: which classes of drugs are being used for migraine prophylaxis, if there is a drug being used in preference to other drugs, how many preventative treatment options are tried before a preventative treatment is successful, if appropriate dosing regimens are being used for preventative treatment options, the common side effects (if any) of the drugs used in the management of migraine prophylaxis and if a different class of drug is being used for children under 12 years of age and over 12 years of age.

Main Results

Propranolol, topiramate, pizotifen, amitriptyline and gabapentin were medication used as initial treatment for paediatric migraine prophylaxis. Pizotifen was the most commonly used medication (n=71) and had the overall highest positive response rate of 76%. Topiramate, pizotifen and amitriptyline were noted to have caused side effects and prevent the subjects from continuing that course of prophylactic treatment. Age is a clinical factor which can influence the decision to start therapy. With a child’s advancing age, the features of childhood migraine change and therefore different medication may respond to the changing condition. It is evident from this research, pizotifen is used for children under the age of 12 years. However the true reason behind this is unknown. This could be due to the medication licensing or the side effect profile. Further trials are needed to review the demanding consideration on migraine in children of different ages. The BNF-C gives dosing advice on three preventative treatments; pizotifen, topiramate and propranolol. There was overall good compliance with dosing as per the BNFC; 91% in the pizotifen group, 100% in the topiramate group and 82% compliance in the propranolol group. In the BNF-C, for amitriptyline and gabapentin there is no dosing advice for migraine prophylaxis. Therefore, there was no dosing regimens to compare to and achieved 0% compliance with the BNF-C.

Conclusion

This research has found pizotifen to be first line treatment for the prevention of migraines. Numerous medication have been identified as potentially preventing migraine but these have either not progressed to fruition or failed to achieve the expected outcomes. Further medication studies are needed to examine their effectiveness for preventing paediatric migraine.

References

Barnes N. ( 2019) ‘Migraine Headache in Children’, British Medical Journal. Available at: https://bestpractice.bmj.com/topics/en-gb/678/evidence (Accessed February 2019)

Bille BO. ( 1997) ‘A 40-year follow-up of children with migraine’. Cephalalgia 1997;17:488–91. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9209767 (Accessed January 2019)

Brandes JL Saper JR, Diamond M, et al. (2004) ‘Topiramate for migraine prevention: A randomized controlled trial’. JAMA. 2004;291:965–973. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14982912 (Accessed January 2019)

Forsythe WI, Gillies D, Sills MA. ( 1984) ‘Propranolol in the treatment of childhood migraine’, Developmental Medicine and Child Neurology Journal, 26: 737–41.