Objectives: To systematically review all randomized controlled trials that examine abortive drug
therapy for migraine in children between 3 and 18 years of age.
Methods: Six electronic bibliographic databases were searched. Trials were included if they
examined children with acute migraine and compared a drug to placebo, another drug,
or standard care. Inclusion criteria were applied and methodological quality was assessed
independently by two reviewers. Data were extracted using a structured form. Standard
meta-analytic methods were used to combine study results.
Results: Sixteen studies were included; few compared the same drugs. The most frequently studied
class of drugs was the triptans (n=12); seven of these compared sumatriptan to placebo.
Overall, the triptans showed mild benefit over placebo with respect to headache alleviation
(RR 1.13; 95% CI 1.06, 1.20) and complete headache relief (RR 1.34; 95% CI 1.18, 1.52).
Although the triptans resulted in more adverse events compared to placebo (RD 0.15;
95% CI 0.07, 0.23), in all cases these were minor. There was evidence of publication
bias suggesting that the observed effects may be overestimates. Subgroup analyses
showed some variation in efficacy by age, study design, and methodological quality.
Headache alleviation and complete headache relief were significantly improved for
ibuprofen vs. placebo (n=2), prochlorperazine vs. ketorolac (n=1), and rizatriptan
vs. standard care (n=1); ibuprofen significantly reduced headache recurrence compared
to placebo (n=2). There were no significant differences for acetaminophen vs. placebo
(n=1), dihydroergotamine vs. placebo (n=1), or acetaminophen vs. ibuprofen (n=1).
Placebo response rates varied greatly from study to study causing some heterogeneity
in the estimates.
Conclusion: Triptans, ibuprofen, and prochlorperazine may be somewhat effective as abortive therapy
for migraines in children. There is a paucity of evidence for other medications.
