Sistematik Bir İnceleme ve Meta-Analiz: Pediatrik ve Ergen Popülasyonlarda Akut Migren Tedavisi

Abstract

Backgrounds: The array of medications used to treat acute migraine in adults is extensive, with several now authorized for use in children and adolescents in outpatient settings. 
 Aims: The aim of this meta-analysis was to evaluate the impact of pharmacological interventions, regardless of the method of delivery, compared to placebo, in treating migraine among individuals aged 18 years or younger. 
 Materials and Methods: We searched PubMed, EMBASE, and Cochrane Library for comparative RCTs published 30 years before May 2023. We included prospective randomized controlled clinical trials of children and adolescents with migraine, comparing acute symptom-relieving migraine medications with a placebo. 
 Results: Twelve clinical trials were included in this meta-analysis. The migraine treatment choice and the proportion of patients with complete pain relief at 2 hours post-treatment were analyzed. Ibuprofen (n=2), sumatriptan (n=3), zolmitriptan (n=3), and rizatriptan (n=4) were used for the analysis. Notably, sumatriptan did not exhibit significant differences compared to placebo, despite mixed individual study outcomes (OR:1.35; 95% CI 0.81, 2.27). Rizatriptan displayed varying efficacies across age groups, showing no significant difference in adolescents aged 12-17 years (p>0.05). Zolmitriptan showed dose-dependent effectiveness, with higher doses yielding better outcomes (OR:2.18; 95% CI 1.45,3.28). Ibuprofen emerged as the sole non-triptan medication to demonstrate efficacy in achieving pain-free status at 2 hours, with a favorable safety profile (OR:2.54; 95% CI 1.20, 5.37).
 Conclusion: These findings suggest that ibuprofen, zolmitriptan, and rizatriptan are potential treatment options for rapidly relieving migraine in children and adolescents. However, ibuprofen may have advantages over triptans, owing to its convenience and cost-effectiveness.