Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society
Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society
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DOI：
10.1212/wnl.0000000000008105
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发表时间：
2019-09-10
期刊：
影响因子：
9.9
通讯作者：
Hershey, Andrew D.
中科院分区：
文献类型：
--
作者：
Oskoui, Maryam;Pringsheim, Tamara;Hershey, Andrew D.
目的为儿童人群中偏头痛的预防提供最新的循证建议。方法作者系统地回顾了2003年1月至2017年8月的文献，并使用美国神经病学学会2011年的程序制定了实践建议。结果15项关于儿童和青少年偏头痛预防的I-III类研究符合纳入标准。没有足够的证据来确定接受异丙丙胺、奥纳博林毒素A、阿米替林、尼莫地平或氟桂利嗪的儿童和青少年是否比接受安慰剂的儿童和青少年更有可能减少头痛频率。接受普奈洛尔治疗的偏头痛儿童可能比接受安慰剂治疗的儿童头痛频率至少减少50%。服用托吡酯和桂利嗪的儿童和青少年可能比服用安慰剂的儿童和青少年更有可能减少头痛的频率。接受阿米替林加认知行为疗法的偏头痛儿童比接受阿米替林加头痛教育的儿童更有可能减少头痛频率。建议：大多数研究儿童偏头痛预防药物有效性的随机对照试验未能证明优于安慰剂。预防儿童偏头痛的建议包括对影响头痛频率的生活方式和行为因素进行咨询，以及评估和管理与头痛持续性相关的共病疾病。临床医生应就偏头痛预防性治疗的使用与患者和护理人员共同作出决策，包括讨论支持药物治疗的证据的局限性。
ObjectiveTo provide updated evidence-based recommendations for migraine prevention using pharmacologic treatment with or without cognitive behavioral therapy in the pediatric population.MethodsThe authors systematically reviewed literature from January 2003 to August 2017 and developed practice recommendations using the American Academy of Neurology 2011 process, as amended.ResultsFifteen Class I-III studies on migraine prevention in children and adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine, or flunarizine are more or less likely than those receiving placebo to have a reduction in headache frequency. Children with migraine receiving propranolol are possibly more likely than those receiving placebo to have an at least 50% reduction in headache frequency. Children and adolescents receiving topiramate and cinnarizine are probably more likely than those receiving placebo to have a decrease in headache frequency. Children with migraine receiving amitriptyline plus cognitive behavioral therapy are more likely than those receiving amitriptyline plus headache education to have a reduction in headache frequency. Recommendations The majority of randomized controlled trials studying the efficacy of preventive medications for pediatric migraine fail to demonstrate superiority to placebo.Recommendationsfor the prevention of migraine in children include counseling on lifestyle and behavioral factors that influence headache frequency and assessment and management of comorbid disorders associated with headache persistence. Clinicians should engage in shared decision-making with patients and caregivers regarding the use of preventive treatments for migraine, including discussion of the limitations in the evidence to support pharmacologic treatments.