A dilemma in pediatric migraine: Headache or school performance? – A comparison of topiramate and flunarizine

IF 1.3 4区医学 Q4 CLINICAL NEUROLOGY

Brain & Development Pub Date : 2025-07-03 DOI:10.1016/j.braindev.2025.104390

Ünal Akca , Gülfer Akca , Şeyma Karatekin

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引用次数: 0

Abstract

Background

Migraine prophylaxis reduces pain severity and duration in pediatric patients, improving school and social adaptation. Topiramate (TPM) and flunarizine (FLN) are effective monotherapies for migraine prevention. This study compares their efficacy in pain management and impact on school and social life.

Methods

This two-group comparative study (2018–2023) included pediatric patients (aged 9–18 years) diagnosed with episodic or chronic migraine based on International Classification of Headache Disorders, 3rd edition (ICHD-3 beta) criteria. Patients were assessed for demographic characteristics, pain duration, pain frequency, pain intensity using the Visual Analogue Scale (VAS), Pediatric Migraine Disability Assessment Scale (PedMIDAS) scores, side effects, and treatment attitudes at baseline and after three months of TPM or FLN treatment.

Results

Among 226 patients, TPM showed a greater reduction in pain frequency than FLN (9.0 vs. 7.5; p = 0.007). The percentage reduction in monthly pain frequency was higher with TPM (83.5 % vs. 70.7 %; p = 0.022). Side effects were significantly lower in the FLN group. TPM caused weight loss, paresthesia, speech/memory impairment, and appetite reduction, while FLN caused weight gain (p < 0.001). TPM was more effective in reducing pain frequency (relative risk [RR] = 0.118; 95 % confidence interval [CI] -0.946 to -0.681; p = 0.011), pain duration (RR = 0.858, 95 % CI -2.640 to -1.350; p < 0.001), and pain intensity (RR = 0.729, 95 % CI -1.849 to -0.539; p < 0.001). However, FLN was superior in PedMIDAS scores, particularly in school attendance and participation (p < 0.001). No patients withdrew, but some were reluctant to use TPM due to concerns about stigmatization. Notably, substantial placebo effects have been observed in pediatric migraine trials, and the current evidence for the efficacy of preventive medications in this population remains limited.

Conclusion

TPM and FLN are effective migraine treatments. TPM is superior for pain reduction, while FLN has fewer side effects and benefits school attendance and participation. Weight changes and stigma should be considered when prescribing TPM.

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儿童偏头痛的困境：头痛还是学习表现？-托吡酯和氟桂利嗪的比较

背景：偏头痛预防可以减轻儿科患者的疼痛严重程度和持续时间，改善学校和社会适应。托吡酯（TPM）和氟桂利嗪（FLN）是预防偏头痛的有效单一疗法。这项研究比较了他们在疼痛管理方面的疗效以及对学校和社会生活的影响。方法本两组比较研究（2018-2023）纳入了根据国际头痛疾病分类第3版（ICHD-3 beta版）标准诊断为发作性或慢性偏头痛的儿科患者（9-18岁）。使用视觉模拟量表（VAS）、儿童偏头痛残疾评估量表（PedMIDAS）评分、副作用和治疗态度评估患者的人口统计学特征、疼痛持续时间、疼痛频率、疼痛强度，并在TPM或FLN治疗三个月后进行评估。结果226例患者中，TPM组疼痛频率明显低于FLN组(9.0 vs. 7.5；p = 0.007)。TPM组每月疼痛频率降低的百分比更高(83.5% vs. 70.7%；p = 0.022)。FLN组的副作用明显较低。TPM引起体重减轻、感觉异常、语言/记忆障碍和食欲下降，而FLN引起体重增加(p <；0.001)。TPM更有效地减少疼痛频率(相对危险度[RR] = 0.118；95%置信区间[CI] -0.946 ~ -0.681；p = 0.011)、疼痛持续时间(RR = 0.858, 95% CI = -2.640 ~ -1.350；p & lt;0.001)，疼痛强度(RR = 0.729, 95% CI -1.849 ~ -0.539；p & lt;0.001)。然而，FLN在PedMIDAS成绩上更胜一筹，特别是在出勤率和参与度方面(p <；0.001)。没有患者退出，但由于担心污名化，有些患者不愿使用TPM。值得注意的是，在儿童偏头痛试验中已经观察到大量的安慰剂效应，目前关于预防药物在这一人群中的有效性的证据仍然有限。结论tpm和FLN是治疗偏头痛的有效方法。TPM在减轻疼痛方面优于FLN，而FLN的副作用更少，并且有利于上学和参与。在开TPM处方时应考虑体重变化和病耻感。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brain & Development 医学-临床神经学

CiteScore

3.60

自引率

0.00%

发文量

153

审稿时长

50 days

期刊介绍： Brain and Development (ISSN 0387-7604) is the Official Journal of the Japanese Society of Child Neurology, and is aimed to promote clinical child neurology and developmental neuroscience. The journal is devoted to publishing Review Articles, Full Length Original Papers, Case Reports and Letters to the Editor in the field of Child Neurology and related sciences. Proceedings of meetings, and professional announcements will be published at the Editor''s discretion. Letters concerning articles published in Brain and Development and other relevant issues are also welcome.