Clinical predictors of propranolol responsiveness in pediatric migraine: a prospective observational study
Müge Baykan1, Elif Didinmez Taşkırdı2, Özge Baykan Çopuroğlu3
1Department of Pediatric Neurology, Recep Tayyip Erdoğan University, Rize Training and Research Hospital, 53100 Rize, Turkey.
Insights
Both propranolol and behavioral therapy significantly reduce pediatric migraine severity. Vitamin deficiencies predict poorer outcomes, highlighting the need for personalized treatment approaches in children.
Area of Science:
- Neurology
- Pediatrics
- Clinical Trials
Background:
- Pediatric migraine significantly impacts quality of life.
- Comparative effectiveness of propranolol and behavioral interventions requires evaluation.
- Predictors of treatment response in pediatric migraine are not fully understood.
Purpose of the Study:
- To compare the effectiveness of propranolol and behavioral therapy for pediatric migraine.
- To identify clinical and biochemical predictors of treatment response in pediatric migraine patients.
Main Methods:
- Prospective study of 178 pediatric migraine patients (ICHD-3 criteria).
- Group 1 (PedMIDAS <15) received behavioral therapy; Group 2 (PedMIDAS ≥15) received propranolol (1-3 mg/kg/day) for 12 weeks.
- Outcomes included changes in migraine frequency, PedMIDAS, and VAS scores; vitamin D/B12 levels were assessed.
Main Results:
- Both groups showed significant reductions in migraine attacks, PedMIDAS, and VAS scores (p < 0.001).
- No significant difference in percentage reduction of VAS scores between groups.
- Vitamin D and B12 deficiencies predicted poorer outcomes in the propranolol group.
Conclusions:
- Propranolol and behavioral therapy are comparably effective in reducing pediatric migraine disability and pain.
- Identifying clinical (vertigo, tremor) and biochemical (vitamin deficiencies) predictors enables personalized treatment strategies.
- Integrating comorbidity screening and nutritional assessment can optimize pediatric migraine management.
Background:
This study aimed to evaluate the comparative effectiveness of propranolol therapy and structured behavioral interventions in reducing headache severity in pediatric patients and to identify predictors of treatment response.
Methods:
In this prospective, single-center study, 178 pediatric patients diagnosed with migraine based on the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria were enrolled. Participants were allocated into two groups according to baseline Pediatric Migraine Disability Assessment Scale (PedMIDAS) scores: Group 1 (PedMIDAS <15, n = 88) received standardized behavioral therapy, while Group 2 (PedMIDAS ≥15, n = 90) received propranolol (1-3 mg/kg/day) for 12 weeks. Primary outcomes were predefined as changes in monthly migraine attack frequency, PedMIDAS scores, and Visual Analog Scale (VAS)-measured headache intensity. Vitamin D deficiency and vitamin B12 deficiency were evaluated as biochemical predictors, and adherence was monitored bi-weekly.
Results:
Both groups showed significant improvement at week 12. Monthly migraine attacks declined from 3.5 ± 1.6 to 2.1 ± 1.2 in Group 1 and from 6.4 ± 2.1 to 3.1 ± 1.7 in Group 2. PedMIDAS scores decreased from 8.60 ± 3.25 to 5.75 ± 2.52 and 24.40 ± 9.65 to 16.11 ± 7.72, respectively (p < 0.001 both). VAS scores also improved in both groups with no significant between-group difference in percentage reduction. A ≥50% reduction in attack frequency plus ≥1-grade PedMIDAS improvement defined treatment response. In the propranolol group, response was independently associated with benign paroxysmal vertigo and essential tremor, while vitamin D and vitamin B12 deficiency predicted poorer outcomes.
Conclusions:
Both propranolol and structured behavioral therapy effectively reduce migraine-related disability and pain in pediatric patients, yielding comparable proportional improvements. The identification of key clinical and biochemical predictors supports a personalized treatment approach, integrating comorbidity screening and nutritional assessment to optimize outcomes.
Clinical Trial Registration:
ClinicalTrials.gov/NCT07180043, retrospectively registered.
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