Yes this recently published article in Curr Pain #Headache Rep was sort of a let-down for me, but it was not the fault of the authors. The authors did a great job summarizing the current information for 2017. The problem is that all they could do was point out the fact that the CHAMP Trial failed to show that either amitriptyline or topiramate were effective prophylactic treatments for kids with migraine. (See my blog from Feb. 22nd for more information on the CHAMP Trial). They made some very good points including the fact that there are very few migraine clinical trials carried out in children. Because of this, diagnosis and treatment of migraine in children is mostly an extrapolation of what is done in adults. Furthermore, even the preventive medications that appear to be safe in children have not been approved for use in pediatrics by the FDA or the EMA (European Medicines Agency). This fact, along with a paucity of clinical trial results, leads to highly variable treatment practices among physicians. For example, I have heard reports from families living in different areas of the U.S. who see physicians that offer treatment for patients under 18 with botox despite it not being formally approved for pediatric patients by the FDA, some see physicians who do not.
What DO we know then? What have we learned? We know that many of the clinical trials that have been carried out have had negative results and high placebo effects in children. When people speak of this particular high placebo effect I can’t help but wonder: is it possible that children in chronic pain feel even more temporary emotional, if not physical relief and well-being from someone taking their pain seriously than adults do? We also know that migraine treatments that are effective in adults are not necessarily helpful for kids. Migraines in kids tend to be of shorter duration and they also occur with more nausea, vomiting, and abdominal pain. I very much agree with a point the authors made: children aren’t just small adults, maybe they need different medicines. Because I can tell you something else we know: simply NOT effectively treating kids with migraine, especially chronic migraine, isn’t an acceptable option.
I give this article a thumbs up