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Headache

18 February 2020

Why meds may not prevent migraines in kids

The findings of a new study highlight the need for more research into migraine prevention in children and teens, and into the power of the 'placebo effect'.

Migraine drugs that might work for adults won't prevent the debilitating headaches in kids and teens, a new study shows.

A number of drugs are used to prevent migraines, but treatment of youngsters has largely been based on the results of adult studies, the international team of researchers pointed out.

What really works in kids? To find out, the researchers reviewed 23 studies conducted between 1967 and 2018. In total, these studies included more than 2 200 young patients.

About one-quarter of these patients received an inactive placebo, while the remainder were treated with a range of drugs (antiepileptics, antidepressants, calcium channel blockers, blood pressure drugs) or food supplements.

Barely more effective than placebo

None of the medications were more effective than placebo in the long term (five to six months or longer), and only two – propranolol and topiramate – provided benefits in the short term (less than five months), according to the study published online in JAMA Pediatrics.

The bottom line, according to researcher Cosima Locher: "The preventive pharmacological treatment of paediatric migraine with all these drugs is barely more effective than placebo." Locher is with the faculty of psychology at the University of Basel, in Switzerland.

The findings highlight the need for more research into migraine prevention in children and teens, and into the power of the "placebo effect" specifically in these patients, the researchers said.

The results might also point the way to new methods of migraine treatment in children and teens that take into account the expectations of patients and their relationships with their doctors. It's possible that this approach could boost the effects of medication or even help treat migraines without the use of drugs, Locher said in a university news release.

Two experts in the United States agreed that drug therapy might not always work best for kids battling migraine.

Mood changes in kids

In fact, one major recent study showed that "behavioural intervention may be as effective in children as pharmaceuticals, yet is significantly underutilised," said Dr Noah Rosen, who directs the Northwell Health Headache Center in Great Neck, New York. "As this analysis shows, much more work needs to be done to show true value in the medical management of paediatric headaches," he added.

Dr Yili Huang directs the Pain Management Center at Phelps Hospital in Sleepy Hollow, New York. He agreed that "lumping adults and children together in treating migraine is problematic because adult and paediatric migraines can be very different. For example, in children, the pain is usually felt on both sides of the head, compared to only one side in adults."

And Huang stressed that drugs aimed at preventing migraines do come with side effects, including mood changes in kids. "In some cases, the potential side effects outweigh the unclear benefits of preventing migraines with these medications," he said.

In his opinion, "non-medication treatments should be the backbone of prevention for children who suffer with migraines." This includes changes in lifestyle, including "healthy drinking, eating, sleeping, and exercise routines," Huang said.

"In some children, psychological treatment, such as biofeedback techniques, have been demonstrated to be helpful," he added. "These treatments can be effective and are not associated with the potential side effects of medication treatment."

Image credit: Caleb Woods/Unsplash

 

Ask the Expert

Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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