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August 2017

Pediatric Migraine Prevention—First, Do No Harm

Author Affiliations
  • 1Pediatric Headache Center, University of California, San Francisco
  • 2National Institute for Health Research–Wellcome Trust King’s Clinical Research Facility, King’s College London, England
JAMA Neurol. 2017;74(8):893-894. doi:10.1001/jamaneurol.2017.1011

In the wake of the Childhood and Adolescent Migraine Prevention (CHAMP) Study,1 many clinicians have been left wondering how best to treat children and adolescents who have frequent migraine. The CHAMP Study aimed to identify an optimal first-line migraine preventive treatment for those aged 8 to 17 years. After a 4-week baseline run-in period, participants were randomized in a 2:2:1 fashion to either amitriptyline (1 mg/kg/d), topiramate (2 mg/kg/d), or placebo. Both amitriptyline and topiramate are commonly used migraine preventives, and topiramate became US Food and Drug Administration labeled for migraine prevention in adolescents during the conduct of the CHAMP Study. In all 3 arms, approximately 60% of participants met the primary end point of a 50% or greater reduction in headache days at 24 weeks. Participants in the 2 medication arms had more adverse events than those in the placebo arm, worrying some that we might do more harm than good with our prescription pads. However, it would be a disservice to children and adolescents with migraine to conclude from the CHAMP Study that we as physicians have nothing to offer them.