Migraine prevention in children and adolescents

Cephalalgia, the official journal of the International Headache Society, published the article entitled "Cinnarizine and sodium valproate as the preventive agents of pediatric migraine: A randomized double-blind placebo-controlled trial", by Man Amanat, and Mahmoud Reza Ashrafi from the Tehran University of Medical Sciences, Tehran, Iran.

Migraine affects about 8% of children and adolescents. About half of them continue to experience it into adulthood, leading to remarkable disability and a substantial social and financial burden to the patient and society. Early diagnosis and interventions can diminish the burden of the condition. Preventive pharmacologic treatment should be recommended when the frequency of headaches is more than 4 attacks per month or when the quality of life, school attendance or daily activities are restricted. Studies show that migraine preventive treatment can decrease the global burden of migraine. Although various preventive medications have been used for migraine in adults, few have been suggested in a pediatric population.

This paper studied the safety and efficacy of cinnarizine and sodium valproate for migraine prophylaxis in 149 children and adolescents (49 in the cinnarizine, 51 in the sodium valproate, and 49 in the placebo group).

Cinnarizine is a medicine that belongs to the category of antihistaminic medications. It is used to treat problems associated with the inner ear and the brain, dizziness, and sickness associated with motion sickness. Cinnarizine is used to relieve symptoms of motion sickness and balance (vestibular) disorders such as tinnitus (ringing in the ears), vertigo, nausea, and vomiting, as well as Ménières disease (a disorder of the inner ear).

Sodium valproate is a medication primarily used to treat epilepsy and bipolar disorder and to prevent migraine headaches. It is an anticonvulsant drug that is approved for use in epilepsy and bipolar disorder. It has also been used for neuropathic pain and migraine prophylaxis.

The medications were considered effective in reducing (more than 50%) the (frequency) number of migraine attacks and intensity, compared to the placebo group.

"Cinnarizine and sodium valproate may be useful for migraine preventive treatment for children and adolescents. Both medications are safe and well-tolerated in terms of adverse events, but cinnarizine could be considered as a new preventive option for pediatric migraine", explained the authors. Long term safety regarding weight gain should be studied in future trials.