Migraine Meds Help Some Children More Than Others
When kids suffer from migraines, amitriptyline and topiramate are often prescribed. A study proves these medications are effective for many children but reveals a strong placebo effect.
When your child suffers from migraines, you want to do whatever you can to help. That may include filling a prescription for migraine medication.
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Two medications that reduce the frequency of migraines in adults, amitriptyline and topiramate, are often prescribed for children.
The first randomized, placebo-controlled study of the drugs, the Childhood and Adolescent Migraine Prevention, or CHAMP trial, was conducted at 30 U.S. sites, including Cleveland Clinic.
“This trial confirmed that more than half of young migraine patients do benefit from these medications,” says children’s headache specialist A. David Rothner, MD, who took part in the study.
Adds pediatric psychologist Ethan Benore, PhD, “until now, we have had no good evidence that children with migraines benefit from drugs used for the same condition in adults.”
The CHAMP study found that the placebo was just as effective as the medications. But placebo-controlled trials are problematic in children.
“Placebo is a powerful tool, and the placebo rate has always been higher among kids,” says Dr. Rothner. “We’ve seen this over and over again in multicenter headache and pain studies. Are kids more susceptible to suggestion? Are they trying to please us? We really don’t know.”
More than 300 migraine patients, ages 8 to 17, took part in CHAMP. Forty percent were randomly assigned to receive daily amitriptyline, 40 percent received daily topiramate, and 20 percent received a placebo. Doses were gradually increased over two months until target doses were achieved.
The study’s primary goal after four months of treatment was to cut in half the “headache days” reported during the first month.
Throughout the study, patients (or their parents) kept a daily headache diary, tracking headache-related disability, number of headache days and serious adverse events.
Headache frequency was cut in half for 52 percent of the young patients taking amitriptyline, for 55 percent of those on topiramate and for 61 percent of those on the placebo.
The differences among groups were not statistically significant. Neither were differences in headache-related disability or number of headache days.
While the difference in adverse events between children taking medications and placebo was significant, “none of the adverse effects were truly serious,” says Dr. Rothner.
They chiefly involved:
Note: Both amitriptyline, an antidepressant, and topiramate, an anti-seizure drug, carry FDA warnings about potential risks of suicidal thought. A few teens experienced mood changes on the medications, but mood changes were also noted among teens on placebo, says Dr. Rothner.
When one medication doesn’t work or its side effects become a problem, physicians can prescribe a different drug. If no drugs seem to help, “we cannot ethically give children a placebo pill, but we can try to achieve the placebo effect in other ways,” says Dr. Rothner.
He starts by reassuring young migraine patients that they do not have a life-threatening disease and that they’ll get better by following a prescribed treatment plan.
“I spend a lot of time on educating patients and families. Whether it’s the placebo effect or it’s real, it seems to help,” he says. He generally recommends:
Dr. Rothner also uses supplements such as magnesium, riboflavin, enzyme Co-Q10 and butterbur.
In addition, he may recommend that children see a pediatric pain psychologist such as Dr. Benore. They can help kids and teens adopt healthy new daily behaviors, and offer training in relaxation and stress management.