Migraines are a frustrating, painful problem affecting over 6 million children in the U.S. In children who have them frequently, daily medications are sometimes given to try to prevent them. These medications have been studied in adults but not in children except in small studies. Several small studies have suggested that two medications might be effective at preventing migraines in children.
In this new study, topiramate (Topamax) and amitriptyline were tested and compared with placebo (no medication sugar pills). The study was a randomized, double-blind study (the best kind) of 328 children ages 8 to 17 years. Both medications were found to be no more effective than placebo. However, they had unpleasant side effects in some children. The study was stopped early because it became clear that the medications were not having any effect compared with placebo.
Based on this study, these medications are not effective at preventing migraines in children. Larger studies might determine that they are effective in certain subgroups of patients, but right now, they appear to play no role in prevention of migraines in children.
One interesting note: placebo worked in about 61 % of children, reducing headache frequency by at least 50%, an effect that has been seen in other migraine studies. That raises an interesting question about psychological components of migraine treatment. It also shows the importance of well-designed research studies. One could look at this study and conclude that either of the drugs reduced the number of migraines by 50%. That sounds great! However, a placebo did even better. So while it is technically correct that the medications reduced migraines by 50%, it is not relevant, since they were less effective than sugar pills. Unfortunately, many research studies are not as well designed, and/or many times people draw the wrong conclusions from a research study.
In the absence of effective medications to prevent migraines in children, we are left with lifestyle measures such as adequate sleep, healthy diet with regular meals, exercise, and trigger avoidance.
