Systematic Reviews and Meta Analysis
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Sistematik Bir İnceleme ve Meta-Analiz: Pediatrik ve Ergen Popülasyonlarda Akut Migren Tedavisi

Year 2023, , 871 - 878, 30.09.2023
https://doi.org/10.16899/jcm.1347057

Abstract

Arka Plan: Yetişkinlerde akut migreni tedavi etmek için kullanılan ilaç çeşitleri oldukça geniştir ve birçoğunun artık ayakta tedavi ortamlarında çocuklarda ve ergenlerde kullanılmasına izin verilmiştir.
Amaçlar: Bu meta-analizin amacı, 18 yaş ve altındaki bireylerde migren tedavisinde, uygulama yöntemine bakılmaksızın, plaseboya kıyasla farmakolojik müdahalelerin etkisini değerlendirmekti.
Gereçler ve Yöntemler: Mayıs 2023'ten 30 yıl önce yayınlanan karşılaştırmalı RCT'ler için PubMed, EMBASE ve Cochrane Library'yi araştırdık. Migrenli çocuk ve ergenlerde akut semptomları hafifleten migren ilaçlarını plaseboyla karşılaştıran prospektif randomize kontrollü klinik araştırmaları dahil ettik.
Bulgular: Bu meta-analize 12 klinik çalışma dahil edildi. Migren tedavisi seçimi ve tedaviden 2 saat sonra ağrıları tamamen geçen hastaların oranı analiz edildi. Analizde ibuprofen (n=2), sumatriptan (n=3), zolmitriptan (n=3) ve rizatriptan (n=4) kullanıldı. Karışık bireysel çalışma sonuçlarına rağmen (OR:1,35; %95 GA 0,81, 2,27), sumatriptan plaseboya kıyasla anlamlı farklılıklar sergilemedi. Rizatriptanın etkinliği yaş grupları arasında değişkenlik gösterdi ve 12-17 yaş arası ergenlerde anlamlı bir fark görülmedi (p>0,05). Zolmitriptan doza bağımlı etkinlik gösterdi ve daha yüksek dozlar daha iyi sonuçlar verdi (OR:2,18; %95 GA 1,45,3,28). İbuprofen, olumlu bir güvenlik profiliyle (OR:2,54; %95 CI 1,20, 5,37) 2 saatte ağrısız duruma ulaşmada etkinliğini gösteren, triptan olmayan tek ilaç olarak ortaya çıktı.
Sonuç: Bu bulgular ibuprofen, zolmitriptan ve rizatriptanın çocuk ve ergenlerde migreni hızlı bir şekilde hafifletmek için potansiyel tedavi seçenekleri olduğunu göstermektedir. Ancak ibuprofenin kullanışlılığı ve maliyet etkinliği nedeniyle triptanlara göre avantajları olabilir.

References

  • [1] Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30(9):1065-72. doi: 10.1177/0333102409355601. Epub 2010. PMID: 20713557.
  • [2] Linet MS, Stewart WF, Celentano DD, Ziegler D, Sprecher M. An epidemiologic study of headache among adolescents and young adults. JAMA. 1989;261(15):2211-6. PMID: 2926969.
  • [3] Szperka C. Headache in Children and Adolescents. Continuum (Minneap Minn). 2021;27(3):703-731. doi: 10.1212/CON.0000000000000993. PMID: 34048400; PMCID: PMC9455826.
  • [4] Ayatollahi SM, Moradi F, Ayatollahi SA. Prevalences of migraine and tension-type headache in adolescent girls of Shiraz (southern Iran). Headache. 2002;42(4):287-90. doi: 10.1046/j.1526-4610.2002.02082.x. PMID: 12010386.
  • [5] Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52(12):1088-97. doi: 10.1111/j.1469-8749.2010.03793.x. Epub 2010. PMID: 20875042.
  • [6] Bille B. A 40-year follow-up of school children with migraine. Cephalalgia. 1997;17(4):488-91; discussion 487. doi: 10.1046/j.1468-2982.1997.1704488.x. PMID: 9209767.
  • [7] O'Brien HL, Kabbouche MA, Kacperski J, Hershey AD. Treatment of pediatric migraine. Curr Treat Options Neurol. 2015;17(1):326. doi: 10.1007/s11940-014-0326-1. PMID: 25617222.
  • [8] Hämäläinen M, Jones M, Loftus J, Saiers J. Sumatriptan nasal spray for migraine: a review of studies in patients aged 17 years and younger. Int J Clin Pract. 2002;56(9):704-9. PMID: 12469987.
  • [9] Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9, W64. doi: 10.7326/0003-4819-151-4-200908180-00135. Epub 2009. PMID: 19622511.
  • [10] Higgins JP, Altman DG. Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions: Cochrane book series. 2008:187-241.
  • [11] Hämäläinen ML, Hoppu K, Valkeila E, Santavuori P. Ibuprofen or acetaminophen for the acute treatment of migraine in children: a double-blind, randomized, placebo-controlled, crossover study. Neurology. 1997;48(1):103-7. doi: 10.1212/wnl.48.1.103. PMID: 9008503.
  • [12] Lewis DW, Kellstein D, Dahl G, Burke B, Frank LM, Toor S, Northam RS, White LW, Lawson L. Children's ibuprofen suspension for the acute treatment of pediatric migraine. Headache. 2002;42(8):780-6. doi: 10.1046/j.1526-4610.2002.02180.x. PMID: 12390641.6.
  • [13] Ahonen K, Hämäläinen ML, Eerola M, Hoppu K. A randomized trial of rizatriptan in migraine attacks in children. Neurology. 2006;67(7):1135-40. doi: 10.1212/01.wnl.0000238179.79888.44. Epub 2006. PMID: 16943370.
  • [14] Ho TW, Pearlman E, Lewis D, Hämäläinen M, Connor K, Michelson D, Zhang Y, Assaid C, Mozley LH, Strickler N, Bachman R, Mahoney E, Lines C, Hewitt DJ; Rizatriptan Protocol 082 Pediatric Migraine Study Group. Efficacy and tolerability of rizatriptan in pediatric migraineurs: results from a randomized, double-blind, placebo-controlled trial using a novel adaptive enrichment design. Cephalalgia. 2012;32(10):750-65. doi: 10.1177/0333102412451358. Epub 2012. PMID: 22711898.
  • [15] Visser WH, Winner P, Strohmaier K, Klipfel M, Peng Y, McCarroll K, Cady R, Lewis D, Nett R; Rizatriptan Protocol 059 and 061 Study Groups. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: results from a double-blind, single-attack study and two open-label, multiple-attack studies. Headache. 2004;44(9):891-9. doi: 10.1111/j.1526-4610.2004.04171.x. PMID: 15447698.
  • [16] Winner P, Lewis D, Visser WH, Jiang K, Ahrens S, Evans JK; Rizatriptan Adolescent Study Group. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: a randomized, double-blind, placebo-controlled study. Headache. 2002;42(1):49-55. doi: 10.1046/j.1526-4610.2002.02013.x. PMID: 12005275.
  • [17] Ahonen K, Hämäläinen ML, Rantala H, Hoppu K. Nasal sumatriptan is effective in treatment of migraine attacks in children: A randomized trial. Neurology. 2004;62(6):883-7. doi: 10.1212/01.wnl.0000115105.05966.a7. PMID: 15037686.
  • [18] Fujita M, Sato K, Nishioka H, Sakai F. Oral sumatriptan for migraine in children and adolescents: a randomized, multicenter, placebo-controlled, parallel group study. Cephalalgia. 2014;34(5):365-75. doi: 10.1177/0333102413510213. Epub 2013. PMID: 24163282.
  • [19] Winner P, Rothner AD, Wooten JD, Webster C, Ames M. Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo-controlled, acute study. Headache. 2006;46(2):212-22. doi: 10.1111/j.1526-4610.2006.00339.x. PMID: 16492230.
  • [20] Winner P, Farkas V, Štillová H, Woodruff B, Liss C, Lillieborg S, Raines S; TEENZ Study Group. Efficacy and tolerability of zolmitriptan nasal spray for the treatment of acute migraine in adolescents: Results of a randomized, double-blind, multi-center, parallel-group study (TEENZ). Headache. 2016;56(7):1107-19. doi: 10.1111/head.12859. Epub 2016. PMID: 27329280.
  • [21] Yonker ME, McVige J, Zeitlin L, Visser H. A multicenter, randomized, double-blind, placebo-controlled, crossover trial to evaluate the efficacy and safety of zolmitriptan nasal spray for the acute treatment of migraine in patients aged 6 to 11 years, with an open-label extension. Headache. 2022;62(9):1207-1217. doi: 10.1111/head.14391. PMID: 36286602..
  • [22] Lewis DW, Winner P, Hershey AD, Wasiewski WW; Adolescent Migraine Steering Committee. Efficacy of zolmitriptan nasal spray in adolescent migraine. Pediatrics. 2007;120(2):390-6. doi: 10.1542/peds.2007-0085. PMID: 17671066.

A Systematic Review and Meta-Analysis: Acute Migraine Treatment in Pediatric and Adolescent Populations

Year 2023, , 871 - 878, 30.09.2023
https://doi.org/10.16899/jcm.1347057

Abstract

Backgrounds: The array of medications used to treat acute migraine in adults is extensive, with several now authorized for use in children and adolescents in outpatient settings.
Aims: The aim of this meta-analysis was to evaluate the impact of pharmacological interventions, regardless of the method of delivery, compared to placebo, in treating migraine among individuals aged 18 years or younger.
Materials and Methods: We searched PubMed, EMBASE, and Cochrane Library for comparative RCTs published 30 years before May 2023. We included prospective randomized controlled clinical trials of children and adolescents with migraine, comparing acute symptom-relieving migraine medications with a placebo.
Results: Twelve clinical trials were included in this meta-analysis. The migraine treatment choice and the proportion of patients with complete pain relief at 2 hours post-treatment were analyzed. Ibuprofen (n=2), sumatriptan (n=3), zolmitriptan (n=3), and rizatriptan (n=4) were used for the analysis. Notably, sumatriptan did not exhibit significant differences compared to placebo, despite mixed individual study outcomes (OR:1.35; 95% CI 0.81, 2.27). Rizatriptan displayed varying efficacies across age groups, showing no significant difference in adolescents aged 12-17 years (p>0.05). Zolmitriptan showed dose-dependent effectiveness, with higher doses yielding better outcomes (OR:2.18; 95% CI 1.45,3.28). Ibuprofen emerged as the sole non-triptan medication to demonstrate efficacy in achieving pain-free status at 2 hours, with a favorable safety profile (OR:2.54; 95% CI 1.20, 5.37).
Conclusion: These findings suggest that ibuprofen, zolmitriptan, and rizatriptan are potential treatment options for rapidly relieving migraine in children and adolescents. However, ibuprofen may have advantages over triptans, owing to its convenience and cost-effectiveness.

References

  • [1] Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30(9):1065-72. doi: 10.1177/0333102409355601. Epub 2010. PMID: 20713557.
  • [2] Linet MS, Stewart WF, Celentano DD, Ziegler D, Sprecher M. An epidemiologic study of headache among adolescents and young adults. JAMA. 1989;261(15):2211-6. PMID: 2926969.
  • [3] Szperka C. Headache in Children and Adolescents. Continuum (Minneap Minn). 2021;27(3):703-731. doi: 10.1212/CON.0000000000000993. PMID: 34048400; PMCID: PMC9455826.
  • [4] Ayatollahi SM, Moradi F, Ayatollahi SA. Prevalences of migraine and tension-type headache in adolescent girls of Shiraz (southern Iran). Headache. 2002;42(4):287-90. doi: 10.1046/j.1526-4610.2002.02082.x. PMID: 12010386.
  • [5] Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52(12):1088-97. doi: 10.1111/j.1469-8749.2010.03793.x. Epub 2010. PMID: 20875042.
  • [6] Bille B. A 40-year follow-up of school children with migraine. Cephalalgia. 1997;17(4):488-91; discussion 487. doi: 10.1046/j.1468-2982.1997.1704488.x. PMID: 9209767.
  • [7] O'Brien HL, Kabbouche MA, Kacperski J, Hershey AD. Treatment of pediatric migraine. Curr Treat Options Neurol. 2015;17(1):326. doi: 10.1007/s11940-014-0326-1. PMID: 25617222.
  • [8] Hämäläinen M, Jones M, Loftus J, Saiers J. Sumatriptan nasal spray for migraine: a review of studies in patients aged 17 years and younger. Int J Clin Pract. 2002;56(9):704-9. PMID: 12469987.
  • [9] Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9, W64. doi: 10.7326/0003-4819-151-4-200908180-00135. Epub 2009. PMID: 19622511.
  • [10] Higgins JP, Altman DG. Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions: Cochrane book series. 2008:187-241.
  • [11] Hämäläinen ML, Hoppu K, Valkeila E, Santavuori P. Ibuprofen or acetaminophen for the acute treatment of migraine in children: a double-blind, randomized, placebo-controlled, crossover study. Neurology. 1997;48(1):103-7. doi: 10.1212/wnl.48.1.103. PMID: 9008503.
  • [12] Lewis DW, Kellstein D, Dahl G, Burke B, Frank LM, Toor S, Northam RS, White LW, Lawson L. Children's ibuprofen suspension for the acute treatment of pediatric migraine. Headache. 2002;42(8):780-6. doi: 10.1046/j.1526-4610.2002.02180.x. PMID: 12390641.6.
  • [13] Ahonen K, Hämäläinen ML, Eerola M, Hoppu K. A randomized trial of rizatriptan in migraine attacks in children. Neurology. 2006;67(7):1135-40. doi: 10.1212/01.wnl.0000238179.79888.44. Epub 2006. PMID: 16943370.
  • [14] Ho TW, Pearlman E, Lewis D, Hämäläinen M, Connor K, Michelson D, Zhang Y, Assaid C, Mozley LH, Strickler N, Bachman R, Mahoney E, Lines C, Hewitt DJ; Rizatriptan Protocol 082 Pediatric Migraine Study Group. Efficacy and tolerability of rizatriptan in pediatric migraineurs: results from a randomized, double-blind, placebo-controlled trial using a novel adaptive enrichment design. Cephalalgia. 2012;32(10):750-65. doi: 10.1177/0333102412451358. Epub 2012. PMID: 22711898.
  • [15] Visser WH, Winner P, Strohmaier K, Klipfel M, Peng Y, McCarroll K, Cady R, Lewis D, Nett R; Rizatriptan Protocol 059 and 061 Study Groups. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: results from a double-blind, single-attack study and two open-label, multiple-attack studies. Headache. 2004;44(9):891-9. doi: 10.1111/j.1526-4610.2004.04171.x. PMID: 15447698.
  • [16] Winner P, Lewis D, Visser WH, Jiang K, Ahrens S, Evans JK; Rizatriptan Adolescent Study Group. Rizatriptan 5 mg for the acute treatment of migraine in adolescents: a randomized, double-blind, placebo-controlled study. Headache. 2002;42(1):49-55. doi: 10.1046/j.1526-4610.2002.02013.x. PMID: 12005275.
  • [17] Ahonen K, Hämäläinen ML, Rantala H, Hoppu K. Nasal sumatriptan is effective in treatment of migraine attacks in children: A randomized trial. Neurology. 2004;62(6):883-7. doi: 10.1212/01.wnl.0000115105.05966.a7. PMID: 15037686.
  • [18] Fujita M, Sato K, Nishioka H, Sakai F. Oral sumatriptan for migraine in children and adolescents: a randomized, multicenter, placebo-controlled, parallel group study. Cephalalgia. 2014;34(5):365-75. doi: 10.1177/0333102413510213. Epub 2013. PMID: 24163282.
  • [19] Winner P, Rothner AD, Wooten JD, Webster C, Ames M. Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo-controlled, acute study. Headache. 2006;46(2):212-22. doi: 10.1111/j.1526-4610.2006.00339.x. PMID: 16492230.
  • [20] Winner P, Farkas V, Štillová H, Woodruff B, Liss C, Lillieborg S, Raines S; TEENZ Study Group. Efficacy and tolerability of zolmitriptan nasal spray for the treatment of acute migraine in adolescents: Results of a randomized, double-blind, multi-center, parallel-group study (TEENZ). Headache. 2016;56(7):1107-19. doi: 10.1111/head.12859. Epub 2016. PMID: 27329280.
  • [21] Yonker ME, McVige J, Zeitlin L, Visser H. A multicenter, randomized, double-blind, placebo-controlled, crossover trial to evaluate the efficacy and safety of zolmitriptan nasal spray for the acute treatment of migraine in patients aged 6 to 11 years, with an open-label extension. Headache. 2022;62(9):1207-1217. doi: 10.1111/head.14391. PMID: 36286602..
  • [22] Lewis DW, Winner P, Hershey AD, Wasiewski WW; Adolescent Migraine Steering Committee. Efficacy of zolmitriptan nasal spray in adolescent migraine. Pediatrics. 2007;120(2):390-6. doi: 10.1542/peds.2007-0085. PMID: 17671066.
There are 22 citations in total.

Details

Primary Language English
Subjects Pediatric Emergency, Pediatric Neurology
Journal Section Original Research
Authors

Emine Özdemir Kaçer 0000-0002-0111-1672

Can Ateş 0000-0003-2286-4398

Publication Date September 30, 2023
Acceptance Date September 20, 2023
Published in Issue Year 2023

Cite

AMA Özdemir Kaçer E, Ateş C. A Systematic Review and Meta-Analysis: Acute Migraine Treatment in Pediatric and Adolescent Populations. J Contemp Med. September 2023;13(5):871-878. doi:10.16899/jcm.1347057