Have a kid with mi­graines? Sugar pills work as well as drugs

Malta Independent - - HEALTH -

Sugar pills worked as well at pre­vent­ing kids’ mi­graines as two com­monly used headache medicines, but had fewer side ef­fects, in a study that may lead doc­tors to re­think how they treat a com­mon ail­ment in chil­dren and teens.

It’s the first rig­or­ous head-to­head test in kids of two generic pre­scrip­tion drugs also used for adults’ mi­graines: top­i­ra­mate, an anti-seizure medicine, and amitripty­line, an anti-de­pres­sant. The idea was to see if either drug could re­duce by half the num­ber of days kids had mi­graines over a month’s time. Both drugs worked that well - but so did placebo sugar pills.

The re­sults “re­ally chal­lenge what is typ­i­cal prac­tice to­day by headache spe­cial­ists,” said study au­thor Scott Pow­ers, a psy­chol­o­gist at Cincin­nati Chil­dren’s Hos­pi­tal’s headache cen­ter.

The study was re­leased on­line Thurs­day in the New Eng­land Jour­nal of Medicine. The Na­tional In­sti­tute of Neu­ro­log­i­cal Disor­ders and Stroke and Na­tional In­sti­tute of Child Health and Hu­man De­vel­op­ment paid for the re­search.

“The fact that it shows that two of the most com­monly used med­i­ca­tions are no more ef­fec­tive than a placebo and have adverse ef­fects makes a very clear state­ment,” said Dr. Leon Ep­stein, neu­rol­ogy chief at Ann & Robert Lurie H. Chil­dren’s Hos­pi­tal of Chicago. Ep­stein said it should lead neu­rol­o­gists to rely on other prevention strate­gies; he ad­vises lifestyle changes in­clud­ing get­ting more sleep and re­duc­ing stress, which he said can help pre­vent mi­graines in teen pa­tients.

Up to 10 per­cent of U.S. schoolaged kids have mi­graines; the de­bil­i­tat­ing headaches tend to per­sist into the teen years and adult­hood. Over-the-counter anti-in­flam­ma­tory medicines in­clud­ing ibupro­fen and ac­etaminophen can help re­duce symp­toms. The only gov­ern­ment-ap­proved mi­graine med­i­ca­tion for kids is top­i­ra­mate, which is known by the brand names Topa­max and Qudexy, but it is only ap­proved for those 12 and up.

The two study drugs are in­ex­pen­sive and used in chil­dren and teens in part be­cause of ben­e­fits seen with adults, but there’s no strong re­search show­ing they are ef­fec­tive in kids, Pow­ers said.

The study in­cluded about 300 kids aged 8 to 17, en­rolled at 31 cen­ters. They had 11 mi­graines on av­er­age in the month be­fore the study be­gan and were ran­domly as­signed to take either of the drugs or placebo pills daily for six months. Mi­graine fre­quency in the study’s last month was com­pared with what kids ex­pe­ri­enced be­fore the study. At least half of kids in each group achieved the study goal, re­duc­ing mi­graine fre­quency by half.

Side ef­fects from the drugs were com­mon, in­clud­ing fa­tigue, dry mouth and for­get­ful­ness. Al­most one-third of kids on top­i­ra­mate also had tin­gling sen­sa­tions in their hands, arms, legs or feet. There was one sui­cide at­tempt in the top­i­ra­mate group, an­other known side-ef­fect of that drug.

The side ef­fects were not un­ex­pected, but given the risks, the re­sults sug­gest the drugs shouldn’t be “first-line prevention treat­ments” for kids’ mi­graines, Pow­ers said.

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