Prophylactic Treatment for Migraine in Children: Amitriptyline or Topiramate?

摘要

Migraine headache is frequently seen in children and causes deterioration of quality of life. Prophylactic treatment is required if the frequency of headaches is more than one per week or headaches cause severe disability. Prophylactic treatment is used to reduce frequency, severity and duration of attacks, improve response to acute treatment of attacks, reduce disability, and improve quality of life. There are limited randomized- controlled studies on the treatment of migraine in children and there is no proven drug for use in migraine prophylaxis in children aged below 12 years (1). A double-blind, placebo-controlled crossover study showed that flunarizine was effective in migraine prophylaxis in 70 children aged between 5-11 years (2). In line with the results of this study, the American Academy of Neurology reported that flunarizine was probably effective in migraine prophylaxis in children, but flunarizine is not approved in the United States of America (1). For this reason, a multi-center, double-blind, randomized, placebo-controlled study was designed to compare the efficacy of amitriptyline and topiramate with placebo, which are widely used by physicians who specialize in pediatric headache (3). In the study, 328 patients whose ages ranged between 8 and 17 years and who were diagnosed as having migraine with or without aura or chronic migraine without daily headaches according to the International Classification of Headache Disorders were included. Patients were randomly assigned to receive amitriptyline (1 mg/kg/day), topiramate (2 mg/kg/day) or placebo for 24 weeks and the efficacy of amitriptyline and topiramate was compared against placebo.