Sodium Valproate versus Propranolol in paediatric migraine prophylaxis

Ashrafi, Mahmoud Reza; Shabanian, Reza; Zamani, Gholamreza; Mahfelati, F.

doi:10.1016/j.ejpn.2005.05.004

Cited by 49 publications

(34 citation statements)

References 25 publications

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“…We assessed for small study effects (publication bias) using the methods of Peters (42) for dichotomous outcomes and Eggers (43) for continuous ones. We explored the potential source of heterogeneity using stratified analysis and meta-regression (44). All analyses were done using STATA (v 12.0, College Station TX).…”

Section: Methodsmentioning

confidence: 99%

Pharmacologic Treatment of Pediatric Headaches

El‐Chammas¹,

Keyes²,

Thompson³

et al. 2013

JAMA Pediatr

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Background Childhood migraines are a common source of morbidity. Purpose To assess the comparative effectiveness and side effects of migraine prophylactic medications in children. Data Sources PUBMED, EMBASE, Cochrane Trial Registry, bibliography of retrieved articles through 25 April 2012. Study Selection Randomized trials of children with migraine headaches. Data Extraction Extracted independently in duplicate, including quality (JADAD, Cochrane Risk of Bias). We pooled headache frequency per month using random effects methods. Data Synthesis Among 21 included trials, there were 13 placebo controlled and 11 comparative effectiveness trials (3 included placebo arms. Drugs more effective than placebo for episodic migraines (<15 headaches/month) included topiramate (−0.71 headaches/month, 95 % CI: −1.19 to −0.24, Q= 1.58, df=1, I2=0.0%) and trazodone (−0.60 headache/month, 95% CI: −1.09 to −0.11, 1 study, Figure 2). Ineffective drugs included clonidine, flunarizine, pizotifen, propranolol and valproate. A single trial of fluoxetine for chronic daily headaches found it ineffective. Patients given placebo experienced a significant (p=0.027) decline in headaches from 5.6 (95% CI: 4.52–6.77 Q=8.14, df=8, I2=1.7%) to 2.9 headaches/month (95% CI: 1.66–4.08, Q-4.72, df=10, I2=0.0%). Among the 10 comparative effectiveness trials, flunarizine was more effective than piracetam (−2.2 headaches/month, 9 CI: −3.93 to −0.47), but no better than aspirin, dihydroergotamine, and propranolol. Propranolol was compared to valproate as well as behavioral treatment and two studies compared different doses of topiramate; none of these trials showed a significant difference. Limitations Few trials, lack of patient level data, changing definitions of migraine over time, few comparative effectiveness trials. Conclusion Topiramate and trazodone have limited evidence supporting efficacy for episodic migraines. Placebo was effective in reducing headaches. Other commonly used drugs have no evidence supporting their use in children. Research in pediatric headaches is needed.

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Section: Methodsmentioning

confidence: 99%

Pharmacologic Treatment of Pediatric Headaches

El‐Chammas¹,

Keyes²,

Thompson³

et al. 2013

JAMA Pediatr

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“…The results showed no significant difference in all therapeutic effects between the two molecules, with a mean of 70% response and a reduction of >50% in headache frequency [67]. …”

Section: Clinical Trials With Vpamentioning

confidence: 99%

Molecular and Therapeutic Potential and Toxicity of Valproic Acid

Chateauvieux

Morceau

Dicato

et al. 2010

Journal of Biomedicine and Biotechnology

396

308

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Valproic acid (VPA), a branched short-chain fatty acid, is widely used as an antiepileptic drug and a mood stabilizer. Antiepileptic properties have been attributed to inhibition of Gamma Amino Butyrate (GABA) transaminobutyrate and of ion channels. VPA was recently classified among the Histone Deacetylase Inhibitors, acting directly at the level of gene transcription by inhibiting histone deacetylation and making transcription sites more accessible. VPA is a widely used drug, particularly for children suffering from epilepsy. Due to the increasing number of clinical trials involving VPA, and interesting results obtained, this molecule will be implicated in an increasing number of therapies. However side effects of VPA are substantially described in the literature whereas they are poorly discussed in articles focusing on its therapeutic use. This paper aims to give an overview of the different clinical-trials involving VPA and its side effects encountered during treatment as well as its molecular properties.

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“…Furthermore, both drugs were found to effectively reduce the severity and duration of headache and to improve the response to rescue medications ( P value <0.01). There was no significant difference between the two groups in any of the aforementioned therapeutic effects ( P value <0.05) [40]. …”

Section: Prophylactic Treatment Of Pediatric Migrainementioning

confidence: 99%

Migraine treatment in developmental age: guidelines update

et al. 2010

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There is a serious lack of controlled studies on the pharmacological treatment of primary migraine in the developmental age; there is, consequently, an urgent need for new, evidence-based approaches to this long-neglected field of research. Moreover, previous studies have stated that the placebo response is greater in pediatric patients than in adults and that a reduction in the attack frequency in the absence of any pharmacological treatment is observed more frequently in pediatric migraine patients than in adults. Besides these preliminary considerations, the shorter duration of migraine attacks and other characteristic semeiological features of the clinical picture in children are such that the design of randomized controlled trial (RCT) is more problematic in the developmental age than in the adult. Bearing in mind all these weak points, the aim of this review was to summarize and update recent guidelines for the treatment of primary migraine in children and adolescents. The most recent guidelines are those published by the Italian Society for the study of Headache, the French Society for the study of Migraine and Headache, and the American Academy of Neurology. We have incorporated into these guidelines the results from the few, recent RCTs, clinical controlled trials, open-label studies, meta-analyses and reviews that have been published since 2004; owing to the lack of strong evidence in this field of research, we have sometimes even mentioned pilot non-controlled studies, case series and expert opinions. Lastly, evidence was classified and the recommendations were categorized according to different levels.

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Sodium Valproate versus Propranolol in paediatric migraine prophylaxis

Cited by 49 publications

References 25 publications

Pharmacologic Treatment of Pediatric Headaches

Pharmacologic Treatment of Pediatric Headaches

Molecular and Therapeutic Potential and Toxicity of Valproic Acid

Migraine treatment in developmental age: guidelines update

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