medwireNews: Pregabalin ranks first out of several treatments that may reduce the frequency and intensity of migraine in children, network meta-analysis findings indicate.
Other treatments also showed “promising results,” but the responses varied by outcome definition, or the data were drawn from individual studies and therefore warrant “cautious interpretation,” report Mansoureh Togha (Tehran University of Medical Sciences, Iran) and co-authors in JAMA Network Open.
They also note that none of the treatments were associated with significant improvements in quality of life or a reduction in the duration of migraine attacks, which they say highlights “the complexity of pediatric migraine management and the need for further research to explore additional therapeutic avenues that may address these aspects of migraine care.”
The comprehensive network meta-analysis included data from 45 trials that assessed oral pharmacologic treatments for pediatric migraine among 3771 patients.
The investigators found that pregabalin reduced migraine frequency, defined as the number of attacks per month, by a significant 62% compared with placebo. The corresponding reduction was a significant 56% with topiramate plus vitamin D3.
In addition, flunarizine, levetiracetam, riboflavin, cinnarizine, topiramate monotherapy, and amitriptyline were associated with significant 54%, 53%, 50%, 36%, 30%, and 27% reductions in migraine frequency, respectively, but only in single studies.
The top three treatments highlighted by p-scores were pregabalin, topiramate plus vitamin D3, and levetiracetam.
Further analyses that assumed additive interactions between the treatments suggested that adding vitamin D3 and riboflavin supplementation to pregabalin may improve the response relative to placebo and pregabalin alone, with mean reductions in migraine frequency of 88% and 69%, respectively.
Headache intensity, a self-reported numeric assessment rating pain intensity from 0 to 10, reduced by a significant 55% during treatment with propranolol and cinnarizine versus placebo, by 43% with pregabalin, 40% with valproate, 38% with levetiracetam, and 36% with cinnarizine.
Treatments most likely to result in at least a 50% reduction in headache frequency relative to baseline included flunarizine plus α-lipoic acid, where the likelihood was a significant 8.73-fold higher than with placebo, flunarizine (4-fold), pregabalin (1.88-fold), and cinnarizine (1.46-fold).
Togha et al conclude that their analysis “sheds light on the pharmacological management of pediatric migraine, revealing that treatments like pregabalin, topiramate (with and without vitamin D3 supplementation), levetiracetam, flunarizine, riboflavin, amitriptyline, and cinnarizine may reduce migraine frequency in pediatric patients.”
The study also “underscores the potential benefits of combination therapies, particularly those involving vitamin supplementation, and emphasizes the importance of larger, randomized clinical trials to confirm these findings and explore new avenues for enhancing care in pediatric migraine management,” they write.
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