[Antiepileptic drugs in pediatric migraine]

Area of Science:

• Neurology
• Pediatrics
• Pharmacology

Background:

• Migraine affects 5-10% of children, with up to 30% requiring daily preventive treatment due to frequent, disabling attacks or treatment inefficacy.
• Pharmacologic treatment for acute migraine attacks often yields unsatisfactory results or adverse effects, necessitating preventive strategies.
• Antiepileptic drugs (AEDs) are frequently investigated for pediatric migraine prophylaxis, yet robust evidence from placebo-controlled studies is limited.

Purpose of the Study:

• To review the evidence for antiepileptic drugs in the preventive therapy of childhood migraine.
• To identify AEDs with proven efficacy in placebo-controlled studies for pediatric migraine.
• To assess the tolerability and common adverse events associated with AEDs used in this population.

Main Methods:

• Systematic review of existing literature on antiepileptic drug use for pediatric migraine prevention.
• Focus on placebo-controlled studies to evaluate drug efficacy.
• Analysis of uncontrolled studies for potential therapeutic candidates.

Main Results:

• Flunarizine and topiramate are the only AEDs with demonstrated efficacy in more than one placebo-controlled study for migraine with and without aura in children.
• Uncontrolled studies suggest potential efficacy for valproic acid, gabapentin, levetiracetam, zonisamide, and magnesium in preventing childhood periodic syndromes, including migraine.
• Most AEDs used in pediatric preventive therapy are generally well-tolerated, with asthenia and somnolence being the most frequently reported adverse events.

Conclusions:

• Limited placebo-controlled evidence exists for most AEDs in pediatric migraine prevention.
• Flunarizine and topiramate represent established options based on current placebo-controlled data.
• Further research is warranted to confirm the efficacy and safety of other AEDs in this patient group, though initial findings are promising.