School children and headaches, stomach aches and other aches are not uncommon combinations. But, for an estimated one in ten children, the headaches are migraine, and can be so debilitating that the child will miss one or two weeks of school in a year. A new Cochrane review from the last Cochrane Library of 2003 brings together evidence on drugs that might be used to reduce the burden of on these children. It highlights the need for better studies, rather than providing a clear answer about which drugs are beneficial.

The Cochrane reviewers discuss the wide international variation in the use of prophylactic therapy for migraine. Drugs that are widely used in some countries are not available in other countries. And there appears to be a lack of a reliable summary of the evidence from controlled studies. The new review rectifies this.

The studies for the review had to be randomised or to have used a process to allocate treatments that, if not random, was unrelated to the child's condition. Participants were children under 18 years of age who had been diagnosed with migraine, and the aim of the interventions tested needed to be either to prevent migraine or to reduce the severity of an attack should one happen. In order to assess this, the reviewers looked at outcomes that the children themselves reported, including the intensity of any headache.

Reports for 38 studies were identified in which drugs were used to prevent migraine. 20 of these studies were judged to be eligible for the review. These were published between 1974 and 1993 and reported on the effects of a variety of treatments. The trials were all relatively small. The largest had only 70 participants, and most studied somewhere between 30 and 50 children.

This combination of a large number of small studies of different drugs makes it difficult to draw strong conclusions about which treatments work and which don't. The reviewers conclude that their analyses do show the usefulness of two drugs: Flunarizine and Propranolol. However, their main conclusion is that many drugs, including some that are commonly used, have not been adequately studied. They call for much bigger and better studies in the future. In a condition that affects so many tens of thousands of children, should their call be heeded, a future update of the review is likely to be much more definite about drugs, kids and migraine. Further Information

The relevant Cochrane review is: Victor S, Ryan SW. Drugs for preventing migraine headaches in children (Cochrane Review).

Insider

January 2004