Study: Pediatric migraine drugs more effective with vitamin supplements
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Key takeaways:
- Supplementing pregabalin and topiramate with vitamin B2 or D enhanced their efficacy for preventing pediatric migraines.
- No drugs had a significant impact on participants’ quality of life.
Pregabalin and topiramate significantly reduced the frequency and intensity of migraines in children and adolescents, especially when combined with vitamin supplements, according to a meta-analysis published in JAMA Network Open.
“To our knowledge, this study represents the largest network meta-analysis conducted to date on pediatric migraine preventive treatment, encompassing a substantial number of patients across multiple studies,” Omid Kohandel Gargari, MD, a researcher at the Iranian Center of Neurological Research at Tehran University of Medical Sciences in Iran, and colleagues wrote.
Gargari and colleagues conducted a systematic review and network meta-analysis of 45 randomized clinical trials encompassing 3,771 total participants aged younger than 18 years. They compared the efficacy of migraine drugs based on patients’ migraine frequency, responder rate and headache duration and intensity.
Out of 37 studies with 2,617 participants that evaluated migraine frequency, the researchers found that pregabalin (ratio of means [RoM] = 0.38; 95% CI, 0.18-0.79), topiramate with vitamin D3 (RoM = 0.44; 95% CI, 0.3-0.65) and levetiracetam (RoM = 0.47; 95% 0.3-0.72) performed the best for reducing migraine frequency vs. placebo. Flunarizine, riboflavin, cinnarizine, topiramate and amitriptyline were also associated with significantly lower migraine frequency compared with placebo. The researchers did not find any significant differences based on age and sex or among those with aura.
Four drugs had a responder rate of more than 50% compared with placebo — meaning headache frequency reduced by 50% or more — according to 29 studies with 2,801 patients. Those were flunarizine (RR = 4; 95% CI, 1.38-11.55), flunarizine and a-lipoic acid (RR = 8.73; 95% CI, 2.44-31.2), pregabalin (RR = 1.88; 95% CI, 1.13-3.14) and cinnarizine (RR = 1.46; 95% CI, 1.04-2.05).
In 19 studies, propranolol with cinnarizine (RoM = 0.45; 95% CI, 0.28-0.72, pregabalin (RoM = 0.57; 95% CI, 0.33-0.96), valproate (RoM = 0.6; 95% CI, 0.49-0.72), levetiracetam (RoM = 0.62; 95% CI, 0.5-0.77) and cinnarizine (RoM = 0.64; 95% CI, 0.54-0.76) significantly reduced participants’ migraine intensity vs. placebo, Gargari and colleagues found.
Supplementing pregabalin with vitamin D3 and riboflavin had an even stronger effect on migraine frequency and intensity compared with placebo or pregabalin alone, the researchers wrote.
Gargari and colleagues did not find a significant association between migraine drugs and quality of life or headache duration, which could be due to the limited data that exist on these topics.
Out of 2,486 participants in 30 studies, 365 reported mild adverse events, and 24 left trials because of serious adverse events. Amitriptyline (RR = 3.81; 95% CI, 1.41-10.32), topiramate (RR = 4.34; 95% CI, 1.6-11.75) and valproate (RR = 5.93; 95% CI, 1.93-18.23) carried the highest risk for adverse events.
“The use of pregabalin and topiramate alone or in combination with high-dose vitamin B2 and D supplementation enhances objective measures of preventive efficacy,” Gargari and colleagues wrote. “Although levetiracetam, cinnarizine and flunarizine also showed promising results, these conclusions were drawn from individual studies, warranting cautious interpretation. Nevertheless, none of the treatments under investigation succeeded in altering patient quality of life or migraine duration.”
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