Acute treatment of paediatric migraine: a meta-analysis of efficacy.
OBJECTIVE
To undertake a meta-analysis of all randomised controlled trials (RCTs) on the acute pharmacologic treatment of children and adolescents with migraine headache.


METHODS
In total, 139 abstracts of clinical trials specific to the acute treatment of paediatric migraine were appraised. Inclusion criteria required clinical trials to be randomised, blinded, placebo-controlled studies with comparable endpoints. Non- English language publications were excluded. 11 clinical trials qualified for inclusion in the final meta-analysis. Two endpoints were analysed: the proportion of patients with (1) headache relief, and (2) complete pain relief, 2 h post-treatment.


RESULTS
The following medications were included in the analysis: acetaminophen (n = 1), ibuprofen (n = 2), sumatriptan (n = 5), zolmitriptan (n = 1), rizatriptan (n = 2) and dihydroergotamine (n = 1). Results are expressed as a relative benefit (RB) conferred over placebo and the number needed to treat (NNT). Only ibuprofen and sumatriptan provided a statistically significant relative efficacy in comparison with placebo. Two hours post-treatment, ibuprofen was associated with an RB 1.50 (95% CI 1.15-1.95) in the generation of headache relief (NNT 2.4) and RB 1.92 (95% CI 1.28-2.86) in the production of complete pain relief (NNT 4.9). Sumatriptan rendered an RB 1.26 (95% CI 1.13-1.41) in headache relief (NNT 7.4) and an RB 1.56 (95% CI 1.26-1.93) in the production of complete pain relief (NNT 6.9).


CONCLUSIONS
Despite the pharmacological options for the management of acute migraine, few RCTs in the paediatric population exist. Composite data demonstrate that only ibuprofen and sumatriptan are significantly more effective than placebo in the generation of headache relief in children and adolescents.
Silver
Shawna
S
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Gano
Dawn
D
Gerretsen
Philip
P
D000082:Acetaminophen / Q000008:administration & dosage; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002648:Child; D004087:Dihydroergotamine / Q000008:administration & dosage; D004341:Drug Evaluation; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage; D008881:Migraine Disorders / Q000188:drug therapy*; D023303:Oxazolidinones / Q000008:administration & dosage; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D017366:Serotonin Receptor Agonists / Q000008:administration & dosage*; D018170:Sumatriptan / Q000008:administration & dosage; D014230:Triazoles / Q000008:administration & dosage; D014363:Tryptamines / Q000008:administration & dosage
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D023303:Oxazolidinones; D010919:Placebos; D017366:Serotonin Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; C089750:zolmitriptan; D000082:Acetaminophen; D004087:Dihydroergotamine; C093622:rizatriptan; D018170:Sumatriptan; D007052:Ibuprofen