DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20174480

Propranolol versus topiramate in prophylaxis of migraines among children and adolescents: a randomized, double-blind clinical trial

Ramakant Yadav, S. K. Shukla

Abstract


Background: Migraine is a common health problem in children and adolescents. This study compares the efficacy and safety of propranolol and topiramate in preventing migraine among children and adolescents.

Methods: Seventy-six patients (10-18 years of age) with migraine without auras defined by the 2004 International Headache society criteria were included in a prospective double blind clinical trial were allocated to receive propranolol (0.5-2mg/kg per day) or topiramate (1-2mg/kg per day). The primary outcome measure was reduction in 50 % or more headache days in comparison to baseline headache frequency per month. Secondary outcome measures were headache related disability, migraine intensity and duration. Efficacy measures were recorded at the baseline and at 12 weeks of prophylactic treatment.

Results: In this study total of 76 patients with mean age of 12.43 years were evaluated, 40 in the propranolol group and 36 in the topiramate group. At the 12-week, the percentage of patients who had a relative reduction of 50% or more in the number of headache days were 67.5% patients in the propranolol group and 75.0% patients in the topiramate group. The monthly migraine frequency, headache related disability, intensity and duration were significantly decreased in both the propranolol and topiramate groups when compared to the baseline. No significant difference was observed between these two groups in term of reduction of frequency, headache related disability, severity and duration of attack. Fatigue, hypotension and exercise induced asthma were main side effects in propranolol group and weight loss, fatigue and loss of appetite, paresthesias in topiramate group.

Conclusions: Propranolol and topiramate were found effective and safe for the prevention of paediatric migraines.


Keywords


Migraine, Propranolol, Paediatric, Prevention, Topiramate

Full Text:

PDF

References


Lewis D. Pediatric migraine. Neurol Clin. 2009;27:481-501.

Lewis DW, Yonker M, Winner P, Sowell M. The treatment of pediatric migraine. Pediatric Annals. 2005;34:448-60.

Abu-Arefeh I, Russdell G. Prevalence of headache and migraine in schoolchildren. BMJ. 1994;309:765-69.

Linet MS, Stewart WF, Celentano DD, Ziegler D, Sprecher M. An Epidemiologic Study of Headache among Adolescents and Young Adults. JAMA: The Journal of the American Medical Association. 1989;261:2211-16.

Stewart WF, Linet MS, Celentano DD, Van Natta M, Ziegler D. Age- and sex-specific incidence rates of migraine with and without visusl aura. Am J Epidemiol. 1991;134:1111-20.

Split W, Neuman W. Epidemiology of Migraine among Students from Randomly Selected Secondary Schools in Lodz. Headache: J Head and Face Pain. 1999;39:494-501.

Hershey AD, Kabbouche MA, Powers SW. Treatment of Pediatric and adolescent migraine. Pediatr Ann. 2010;39:416-23.

Raieli V, Compagno A, Pandolfi E. Headache: what do children and mothers expect from pediatricians? Headache. 2010;50(2):290-300.

Brna PM, Dooley JM. Heradaches in the pediatric population. Semin Pediatr Neurol 2006;13(4):222-30.

Hershey AD, Powers SW, Vockell AL, Lecates S, Kabbouche MA, MaynadMK, Ped MIDAS: development of a questionnaire to assess disability of migraines in children. Neurology. 2001;57:2034-39.

Levis D, Ashwal S, Hershey A, Hirtz D, Yonker M, Silberstein S. Practice Parameter: Pharmacologycal treatment of migraine headache in children and adolescents. Neurol. 2004;63:2215-24.

Ludvigsson J. Propranolol used in prophlaxis of migraine in children. Acta Neurologyca. 1974;50:109-15.

Forsythe WI, Gllies D, Sills MA, Propanolol (‘Inderal’) in the treatment of childhood migraine. Dev Med Child Neurol. 1984;26:737-41.

Brandes JL, Saper JR, Diamond M. Topiramate for migraine Prevention. JAMA. The Journal of American Medical Asscioiation. 2004;291:965-73.

Lakshmi CVS, Singhi P, Malhi P, Ray M. Topiramate in the Prophylaxis of Pediatric Migraine: A Double-Blind Placebo-Controlled Trial. Journal of Child Neurology. 2007;22:829-35.

Winneer P, Pearlman EM, Linder SL. Topiramate for Migraine Prevention in Children: A Randomized, Doule-Blind, Placebo-Controlled Trial. Headache: J Head and Face Pain. 2005;45:1304-12.

Campistol J, Campos J, Casas C, Herranz JL. Topiramate in the prophylactic treatment of migraine in children. J Child Neurol. 2005;20:251-3.

Hershey AD, Powers SW, Vockell A-LB, LeCates S. Kabbouche M. Effectiveness of Topiramate in the Prevention of Childhood Headaches. Headach: The Journal of Head and Face Pain. 2002;42:810-18.

Unalp A, Uran N, Ozturk A. Comparison of the effectiveness of topiramate and sodium valproate in pediatric migraine. J Child Neurol. 2008;23:1377-81.

Headache Clasification Committee of the International Headache Society. The International Classification of Headache Disorders. 2nd edn. Cephalalgia. 2004;24(Suppl. 1):1-160.

Misra UK, Jose M. Kalita J. Rofecoxib versus ibuprofen for acute treatment of migraine: a randomized placebo controlled trial. Postgrad Med J. 2004;80:720-23.

Tonekaboni SH, Ghazavi A, Fayyazi A, Kajeh A, Taghdiri MM, AbdollahGorgi F, et al. Prophylaxis of Childhood Migraine: Topiramate Versus Propranolol. Iran J Child Neurol. 2013; 7(1):9-14.

Fallah R, AkhavanKarbasi S, Shajari A, Fromandi M. The Efficacy and Safety of Topiramate for Prophysaxis of Migraine in Children. Iran J Child Neurol. 2013;7(4):7-11.

Fallah R, Devanizadeh MS, Karimi M, Mirouliaei M, Shamszadeh A. Topiramate and propranolol for prophylaxis of migraine. Indian J Pediatr. 2013;80(11):920-24.

Holroyd KA, Pen Zien DB, Cordingley GE. Propranolol in the management of recurrent migraine a meta-analytic review. Headache. 1991;31:333-40.

Kozubski W, Prusinsk A. Sodium Valproate Versus propranolol in the prophylactic treatment ofmigraine. Neurol Neurochir Pol. 1995;29(6):937-47.

Kaniecki RG. A comparison of divalproex with propranolol and placebo for the prophylaxis of migraine without aura. Arch Neurol. 1997;54(9):1141-45.