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Triptans for treatment of acute pediatric migraine: a systematic literature review
Paul W Major1, Helen S I Grubisa, Norman M R Thie
1Orthodontic Graduate Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Insights
Nasal spray sumatriptan may be effective for acute pediatric migraine when other treatments fail. While generally safe, oral sumatriptan and rizatriptan showed limited benefits in children and adolescents.
Area of Science:
- Pediatric Neurology
- Pharmacology
- Clinical Trials
Background:
- Migraine is a common neurological disorder in children and adolescents.
- Limited evidence exists on the efficacy and safety of triptans for acute migraine treatment in pediatric populations.
Purpose of the Study:
- To evaluate the effectiveness and safety of triptans for treating acute migraine in children and adolescents aged 6-18 years.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) and open-label studies.
- Searched Medline and PubMed databases (1966-2002).
- Included pharmacokinetic studies for triptans in pediatric patients.
Main Results:
- Four RCTs evaluated oral sumatriptan, oral rizatriptan, and nasal sumatriptan.
- Rizatriptan was well-tolerated but showed no clear benefit in adolescents.
- Nasal sumatriptan demonstrated effectiveness in acute pediatric migraine refractory to other treatments.
- Oral sumatriptan's effectiveness was not established.
- Adverse effects for all studied triptans were minor.
Conclusions:
- Nasal spray sumatriptan is a potential option for acute pediatric migraine when standard interventions are inadequate.
- Further research is needed to establish the pharmacokinetics of sumatriptan in pediatric patients.
Abstract:
The purpose of this article is to evaluate the effectiveness and safety of triptans for the treatment of acute migraine in children and adolescents. Randomized and open label trials of triptans in acute pediatric patients (ages 6-18 years) were identified by Medline (1966-2002) and PubMed (1991-2002). Additional reports were identified from the reference list of the retrieved studies. To study effectiveness, only randomized controlled trials were included, but open label studies were also included to study adverse effects. Pharmacokinetic studies of triptans in pediatric patients were also searched. Four randomized controlled trials were identified. One study reported oral sumatriptan, another oral rizatriptan, and two studies reported nasal spray sumatriptan. Rizatriptan is well tolerated but not clearly beneficial when used in adolescents. Effectiveness of nasal spray sumatriptan in acute pediatric migraine where other medications had failed was supported. Effectiveness of oral sumatriptan was not established. Adverse effects were minor for oral sumatriptan and rizatriptan and nasal sumatriptan. Pharmacokinetics of sumatriptan in pediatric patients has not been established. In conclusion, nasal spray sumatriptan should be considered in acute pediatric migraine in patients not experiencing adequate relief with other interventions.
