The prevalence of
migraine in children and adolescents in the United States is quite high
affecting quality of life of patients significantly.
No considerable efficacy of Amitriptyline and Topiramate
over placebo in reducing the number of headache days in pediatric patients was
shown.
The prevalence of migraine in children and adolescents in the United States is quite high affecting quality of life of patients significantly. This disease is also taking a toll on the U.S. economy of approximately $36 billion. The clinical practice guidelines for the management of pediatric migraine are not evidence-based, with no Food and Drug Administration (FDA) approved migraine prevention medication for children younger than 12 years of age. Amitriptyline and Topiramate were found to be the most common drugs used as preventive medications, based on a survey of pediatric headache specialists. "The Childhood and Adolescent Migraine Prevention (CHAMP)" trial was conducted to compare the effectiveness of Amitriptyline and Topiramate in pediatric migraine.
Rationale behind the research:
The medication which can be used for migraine prevention in pediatric patients has not been established yet.
Objective:
To compare the effects of Amitriptyline and Topiramate with placebo in pediatric migraine patients.
Note: This was a phase 3, multicenter, double-blind, placebo-controlled trial
Study outcomes measures
Primary Outcomes: Relative reduction of 50% or more in the number of headache days in the comparison of the 28-day baseline period with the last 28 days of the 24-week trial. Secondary Outcomes: Four secondary outcomes were:
Time Points: 28-day baseline period and the last 28 days of a 24-week trial
Outcomes
In sensitivity analyses using headache data obtained at baseline and week 24, there were 264 patients available for analysis. The percentage of patients with a relative reduction of 50% or more in the number of headache days was 66% with Amitriptyline, 71% with Topiramate, and 68% with placebo. By combining these approaches, the total relative reduction of 50% or more was found in 52 to 66% of the patients in the Amitriptyline group, 55 to 71% of the patients in the Topiramate group, and 61 to 68% of the patients in the placebo group.
Figure 1: Patients with a relative reduction of 50% or More in the Number of Headache Days
Secondary Outcomes:
This trial demonstrated that neither of two preventive medications for pediatric migraine was more effective than placebo in reducing the number of headache days over a period of 24 weeks. Patients who received Amitriptyline or Topiramate had higher rates of adverse events than those who received placebo. In this trial, a high placebo response rate similar to the rate reported in previous headache and pain trials was observed. These findings also recommend that the adult model of headache treatment, in which Amitriptyline and Topiramate have been useful, may not apply to pediatric patients.
NA
Amitriptyline, Topiramate, or placebo are not
significantly effective in reducing the headache frequency or headache-related
disability in childhood and adolescent migraine
N Engl J Med. 2017 January 12; 376(2): 115–124.
Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine
Scott W. Powers et al.
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