Objective:

To evaluate the efficacy of preventive medications for migraine in children and adolescents through a network meta-analysis of randomized clinical trials.

Approach:

• Study Design: Comprehensive network meta-analysis of 45 randomized clinical trials involving 3,771 pediatric patients.
• Outcomes Assessed: Primary outcome was migraine frequency; secondary outcomes included responder rates, headache duration, intensity, and disability.
• Data Analysis: Conducted using a random-effects model due to heterogeneity, with a component meta-analysis for multicomponent treatments.

Key Findings:

• Pregabalin associated with a 62% reduction in migraine frequency (RoM = 0.38, 95% CI = 0.18–0.79).
• Topiramate with vitamin D3 showed a 56% reduction in migraine frequency (RoM = 0.44, 95% CI = 0.30–0.65).
• Flunarizine and α-lipoic acid had the highest 50% responder rate (RR = 8.73, 95% CI = 2.44–31.20).
• Propranolol combined with cinnarizine reduced headache intensity by 55% (RoM = 0.45, 95% CI = 0.28–0.72).
• No treatments showed significant improvements in quality of life or reduction in migraine attack duration.

Interpretation:

Limitations:

• Potential differences in baseline values of outcomes.
• Small sample sizes for some interventions.
• Substantial heterogeneity in dosages, treatment formats, and reporting methods.
• High percentage of participants from Iran may limit generalizability.

Conclusion:

Sources:

• JAMA Network Open