Therapies for Pediatric Migraine: Christina Szperka, MD, MSCE


The director of the Pediatric Headache Program at CHOP commented on the available therapies for children with migraine, as well as future developments. [WATCH TIME: 4 minutes]

WATCH TIME: 4 minutes

“Lack of benefit over placebo in a study, quite frankly, does not mean in my mind that it's not still a really good thing in clinical care, or that it's not still a good tool I could use in clinical care. So, navigating the piece of, ‘How do I take the trials and work with it in real life?’ is tricky.”

Treatment options for pediatric migraine is a growing area of research, with existing therapies such as Calcitonin gene-related peptide, indicated for adults 18 years or older. According to Christina Szperka, MD, MSCE, director, Pediatric Headache Program, Children’s Hospital of Philadelphia, the landscape is “very much changing,” with work being done in ongoing trials of potentially helpful options. 

In conversation with NeurologyLive®, Szperka further discussed neuromodulation devices, with some being indicated for use in children 12 years and older, based on smaller studies or no studies at all. Finding insurance coverage treatment options can be tricky, Szperka said, as the devices may not have gone through the same degree of study that medications have. 

Considering current studies, Szperka also emphasized the need to reflect on what experts have learned up to this point, citing the 2017 Childhood and Adolescent Migraine Prevention (CHAMP) trial (NCT01581281), which evaluated amitriptyline vs topiramate (Topamax; Janssen) vs placebo. The study found no significant between-group differences in the primary outcome of relative reduction of 50% or more in the number of headache days, comparing the 28-day baseline period with the last 28 days of the 24-week trial.

As this did not necessarily demonstrate that medications had benefit over placebo, Szperka commented on the need to maintain caution when implementing trial findings into clinical care and practice. Additionally, in future studies, there is a risk of repeating this outcome, which may be attributed to children’s expectation of benefit, she said. In July 2021, findings from a survey study evaluating youths with longstanding and frequent migraines who participated in the CHAMP trial did show that many individuals maintained improvements in headache status for up to 3 years after treatment. 

Powers SW, Coffey CS, Chamberlin LA, et al. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. N Engl J Med. 2017; 376:115-124. doi:10.1056/NEJMoa1610384
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