Ibuprofen or Acetaminophen for the Acute Treatment of Migraine in Children

Hämäläinen, Mirja; Hoppu, Kalle; Valkeila, Esko; Santavuori, Pirkko

doi:10.1212/wnl.48.1.103

Cited by 300 publications

(160 citation statements)

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“…Nonopioid analgesics were frequently administered in the current study and have been shown to be efficacious for migraine 23 ; the use in the ED setting is difficult to study retrospectively because many patients are given acetaminophen or ibuprofen before arrival in the ED. 5,8 Triptans, a serotonin receptor agonist, have been increasingly used for treatment of acute migraine.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

2015

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BACKGROUND AND OBJECTIVES: Migraine headache is a common pediatric complaint among emergency department (ED) patients. There are limited trials on abortive therapies in the ED. The objective of this study was to apply a comparative effectiveness approach to investigate acute medication regimens for the prevention of ED revisits. METHODS:Retrospective study using administrative data (Pediatric Health Information System) from 35 pediatric EDs (2009EDs ( -2012. Children aged 7 to 18 years with a principal diagnosis of migraine headache were studied. The primary outcome was a revisit to the ED within 3 days for discharged patients. The primary analysis compared the treatment regimens and individual medications on the risk for revisit. RESULTS:The study identified 32 124 children with migraine; 27 317 (85%) were discharged, and 5.5% had a return ED visit within 3 days. At the index visit, the most common medications included nonopioid analgesics (66%), dopamine antagonists (50%), diphenhydramine (33%), and ondansetron (21%). Triptans and opiate medications were administered infrequently (3% each). Children receiving metoclopramide had a 31% increased odds for an ED revisit within 3 days compared with prochlorperazine. Diphenhydramine with dopamine antagonists was associated with 27% increased odds of an ED revisit compared with dopamine antagonists alone. Children receiving ondansetron had similar revisit rates to those receiving dopamine antagonists. CONCLUSIONS:The majority of children with migraines are successfully discharged from the ED and only 1 in 18 required a revisit within 3 days. Prochlorperazine appears to be superior to metoclopramide in preventing a revisit, and diphenhydramine use is associated with increased rates of return.WHAT'S KNOWN ON THE SUBJECT: Migraine headaches are a common presenting complaint in emergency departments. Abortive treatment in this setting is not well studied, leading to considerable variation in treatment. The relationship between acute medications and emergency department revisits has not been studied. WHAT THIS STUDY ADDS:Eighty-five percent of children with migraine are successfully discharged from the emergency department; only 1 in 18 children require a return visit. Prochlorperazine is associated with less revisits than metoclopramide, and diphenhydramine use is associated with increased risk of return visits.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

2015

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“…Ibuprofen resulted in headache relief in 53.8% and On comparing with ibuprofen, rizatriptan was better in relieving pain, associated symptoms and functional disability at 2 h. Rizatriptan has been compared with other triptans and is reported to be superior to sumatriptan, zolmitriptan and naratriptan in 2-h pain relief and 24-h headache freedom [8]. Acetaminophen, aspirin and NSAIDS in migraine have been found to be effective and well tolerated in adults and children [4,14]. In childhood migraine, ibuprofen has been found to be superior to acetaminophen [4].…”

Section: Discussionmentioning

confidence: 99%

“…Acetaminophen, aspirin and NSAIDS in migraine have been found to be effective and well tolerated in adults and children [4,14]. In childhood migraine, ibuprofen has been found to be superior to acetaminophen [4]. There is however no study comparing the relative efficacy of rizatriptan and NSAIDS.…”

Section: Discussionmentioning

confidence: 99%

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Rizatriptan vs. ibuprofen in migraine: a randomised placebo-controlled trial

2007

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The objective of this study was to compare the efficacy of rizatriptan and ibuprofen in migraine. The study was a randomised placebo-controlled trial in a tertiary care teaching hospital. Migraine patients with <8 attacks/months were included. One hundred and fifty-five migraine patients were randomised to rizatriptan 10 mg (53), ibuprofen 400 mg (52) and placebo (50). Efficacy was assessed by headache relief, and headache freedom at 2 h and 24 h. Two-hour headache relief was noted in 73% in rizatriptan, 53.8% in ibuprofen and 8% in placebo groups. Headache freedom was achieved in 37.7% in rizatriptan, 30.8% in ibuprofen and 2% in placebo groups. Rizatriptan was superior to ibuprofen and placebo in relieving headache at 2 h but not at 24 h. Side effects were noted in 9 patients in rizatriptan, 8 in ibuprofen and 3 in placebo, all of which were nonsignificant. Rizatriptan and ibuprofen are superior to placebo. Rizatriptan is superior to ibuprofen in relieving headache, associated symptoms and functional disability.

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“…Using a cutoff point of 6 of 10 criteria, 6 studies (60.0%) were considered to be of high quality. 10,12,13,16,[18][19][20] Most prevalent methodologic shortcomings were a concealed randomization method (unclear: 80%), the intention-to-treat analysis (unclear: 50%; negative: 20%), and comparability of groups at baseline (unclear: 70%; negative: 10%). Table 2 gives an overview of effect estimates of the different treatment modalities described below.…”

Section: Methodologic Qualitymentioning

confidence: 99%

Symptomatic Treatment of Migraine in Children: A Systematic Review of Medication Trials

Damen¹,

Bruijn

Verhagen³

et al. 2005

Pediatrics

117

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ABSTRACT. Objective. Treatment of pediatric migraine includes an individually tailored regimen of both nonpharmacologic and pharmacologic measures. The mainstay of symptomatic treatment in children with migraine is intermittent oral or suppository analgesics, but there is no coherent body of evidence on symptomatic treatment of childhood migraine available. The objective of this review is to describe and assess the evidence from randomized and clinical controlled trials concerning the efficacy and tolerability of symptomatic treatment of migraine in children.Design. Systematic review according to the standards of the Cochrane Collaboration.Methods. Databases were searched from inception to June 2004. Additional reference checking was performed. Two authors independently selected randomized and controlled trials evaluating the effects of symptomatic treatment in children (<18 years old) with migraine, using headache (HA) clinical improvement as an outcome measure. Two authors assessed trial quality independently by using the Delphi list, and data were extracted from the original reports by using standardized forms. Quantitative and qualitative analysis was conducted according to type of intervention.Results. A total of 10 trials were included in this review, of which 6 studies were considered to be of high quality. The number of included participants in each trial ranged from 14 to 653, with a total of 1575 patients included in this review. Mean dropout rate was 19.8% (range: 0 -39.1%), and the mean age of participants was 11.7 ؎ 2.2 years (range: 4 -18 years).All studies used HA diaries to assess outcomes. In most studies, a measure of clinical improvement was calculated by using these diaries. Improvement often was regarded as being clinically relevant when the patients' HA declined by >50%.Regarding oral analgesic treatment, the effectiveness of acetaminophen, ibuprofen, and nimesulide were evaluated. When compared with placebo, acetaminophen (relative risk [RR]: 1.5; 95% confidence interval [CI]: 1.0 -2.1) and ibuprofen (pooled RR: 1.5; 95% CI: 1.2-1.9) significantly reduced HAs. We conclude that there is moderate evidence that both acetaminophen and ibuprofen are more effective in reduction of symptoms 1 and 2 hours after intake than placebo with minor adverse effects. No clear differences in effect were found between acetaminophen and ibuprofen or nimesulide.Regarding the nonanalgesic interventions, nasal-spray sumatriptan, oral sumatriptan, oral rizatriptan, oral dihydroergotamine, intravenous prochlorperazine, and ketorolac were evaluated. When compared with placebo, nasal-spray sumatriptan (pooled RR: 1.4; 95% CI: 1.2-1.7) seemed to significantly reduce HAs. We conclude that there is moderate evidence that nasal-spray sumatriptan is more effective in reduction of symptoms than placebo but with significantly more adverse events. No differences in effect were found between oral triptans and placebo. All medications were well tolerated, but significantly more adverse events were reported for nasalspray suma...

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Ibuprofen or Acetaminophen for the Acute Treatment of Migraine in Children

Cited by 300 publications

References 11 publications

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department

Rizatriptan vs. ibuprofen in migraine: a randomised placebo-controlled trial

Symptomatic Treatment of Migraine in Children: A Systematic Review of Medication Trials

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