Effectiviteit van interventies bij kinderen met migraine

Verhagen AP, Damen L, Bruijn JKJ, Berger MY, Passchier J, Koes BW. Effectiveness of interventions in children with migraine. Huisarts Wet 2006;49(3):123-9. Objective To assess the effectiveness and tolerance of treatment methods for episodes of migraine in children. Methods We performed a systematic review. Databases were searched from inception to June 2004, and references were checked. We selected randomised and controlled trials reporting the effects of symptomatic and prophylactic treatment methods in children with migraine, using headache features as outcome measure. Two independent reviewers assessed trial quality and extracted data. Quantitative and qualitative analyses were carried out according to type of intervention. Results A total of 49 trials (total 3296 patients) were included in this review, of which 16 studies (32.7%) were considered to be of high quality. Ten studies evaluated the effectiveness of acute medication. Compared to placebo, headache improved significantly for acetaminophen, ibuprofen, and nasal sumatriptan. No significant differences were found between acetaminophen and ibuprofen or nimesulide, and between oral sumatriptan, rizatriptan and dihydroergotamine compared to placebo. All medications were well tolerated, but significantly more adverse events were reported for nasal sumatriptan. Nineteen studies evaluated the effectiveness of non-pharmacological prophylactic treatments. When compared to waiting list control, headache improved significantly for relaxation, relaxation plus biofeedback, and relaxation plus biofeedback plus cognitive behavioural treatment. There is conflicting evidence regarding the use of oligoantigenic diets. Lastly, 20 studies evaluated the effectiveness of pharmacological prophylactic treatments. Compared to placebo, headache improved significantly for flunarizine medication. There is conflicting evidence for the use of propranolol. Nimodipine, clonidine, L-5HTP, trazodone and papaverine showed no efficacy when compared to placebo. Conclusions Acetaminophen and ibuprofen are effective symptomatic pharmacological treatments of episodes of migraine in children. Nasal spray sumatriptan is also effective, but more side effects are reported. A few treatments, such as relaxation and flunarizine, may be effective as prophylactic treatment for migraine in children