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Neue US-Empfehlungen zur medikamentösen Behandlung von Kinder-Migräne [Pharma]
21 Jan 05

American Academy of Neurology Quality Standards Subcommittee und Practice Committee of the Child Neurology Society ziehen Schlüsse aus 166 Studien

Das American Academy of Neurology Quality Standards Subcommittee und die Practice Committee of the Child Neurology Society haben 166 Studien analysiert und daraus neue Empfehlungen zur medikamentösen Behandlung der kindlichen Migräne erarbeitet.

Die Ergebnisse zeigen, dass es anders als bei Erwachsenen kaum gesicherte Ergebnisse bzgl. der Wirksamkeit vieler der bei Erwachsenen verbreiteten Migränemitteln gibt.

Die Ergebnisse im Einzelnen:

For acute treatment of Migraine attacks:

  • Sumatriptan (Imitrex® / Imigran®) nasal spray and ibuprofen are effective and are well tolerated versus placebo.
  • Acetaminophen (Tylenol®) is probably effective and is well tolerated versus placebo.
  • Rizatriptan (Maxalt®) and zolmitriptan (Zomig®) were safe and well tolerated but were not superior to placebo.

For daily preventive therapy:

  • Flunarizine (Sibelium®) is probably effective. (Flunarizine is not available in the United States.)
  • The data concerning cyproheptadine (Periactin®), amitriptyline (Elavil®), divalproex sodium (Depakote®, topiramate (Topamax®), and levetiracetam (Keppra®) were insufficient.
  • Conflicting data were found concerning propranolol (Inderal®) and trazodone (Desyrel®).
  • Pizotifen, nimodipine, and clonidine did not show efficacy.

Based on their review of all the available data the committee members made the following recommendations:

For acute treatment of Migraine attacks:

  • Ibuprofen is effective and should be considered for the acute treatment of Migraine attacks in children (over 6).
  • Acetaminophen is probably effective and should be considered for the acute treatment of Migraine attacks in children.
  • Sumatriptan nasal spray is effective and should be considered for the acute treatment of Migraine attacks in adolescents (over 12).
  • There were no data, positive or negative, regarding the use of any oral triptans in children or adolescents.
  • There are inadequate data to determine the efficacy of subcutaneous sumatriptan.

For daily preventive therapy:

  • Flunarizine is probably effective and could be considered but is not available in the United States.
  • There is insufficient evidence to make any recommendations concerning the use of cyproheptadine, amitriptyline, divalproex sodium, topiramate, or levetiracetam.
  • Because the evidence is conflicting, recommendations cannot be made concerning propranolol or trazodone.
  • Pizotifen (Sandomigraine) and nimodipine (Nimotop®) and clonidine did not show efficacy and are not recommended.

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