Departments of Pediatric and Neurology/Neurosurgery, McGill University, Montréal, Quebec, Canada.
Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada.
Headache. 2019 Sep;59(8):1144-1157. doi: 10.1111/head.13625.
To provide updated evidence-based recommendations for migraine prevention using pharmacologic treatment with or without cognitive behavioral therapy in the pediatric population.
The authors systematically reviewed literature from January 2003 to August 2017 and developed practice recommendations using the American Academy of Neurology 2011 process, as amended.
Fifteen class I-III studies on migraine prevention in children in adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine and 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. Recommendations for 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.
为儿科人群使用药物治疗（联合或不联合认知行为疗法）预防偏头痛提供最新的循证推荐意见。
作者系统地检索了 2003 年 1 月至 2017 年 8 月的文献，并采用美国神经病学学会 2011 年修订的流程制定了实践推荐意见。
符合纳入标准的有 15 项针对儿童和青少年偏头痛预防的 I-III 级研究。目前尚无充分证据确定与安慰剂相比，接受丙戊酸钠、肉毒毒素 A、阿米替林、尼莫地平、氟桂利嗪治疗的儿童和青少年头痛发作频率降低的可能性更大或更小。与安慰剂相比，接受普萘洛尔治疗的偏头痛患儿头痛发作频率降低的可能性更大。与安慰剂相比，接受托吡酯和桂利嗪治疗的儿童和青少年头痛发作频率降低的可能性更大。与接受阿米替林联合头痛教育相比，接受阿米替林联合认知行为疗法的偏头痛患儿头痛发作频率降低的可能性更大。推荐意见：大多数研究预防性药物治疗儿童偏头痛疗效的随机对照试验未能证明其优于安慰剂。儿童偏头痛预防的推荐意见包括对影响头痛发作频率的生活方式和行为因素进行咨询，以及对与头痛持续存在相关的合并症进行评估和管理。临床医生应与患者和照护者共同讨论偏头痛预防治疗的使用问题，包括讨论支持药物治疗的证据局限性。
