tag:blogger.com,1999:blog-2186593343917545414.post7812713210532354764..comments2024-03-10T12:29:30.004-07:00Comments on pediatric neurology: Placebo better than amitriptyline or topiramate for pediatric migraineGalen Breningstall, MDhttp://www.blogger.com/profile/07170864203251456228noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2186593343917545414.post-43102399331302350242017-02-07T13:11:35.119-08:002017-02-07T13:11:35.119-08:00For anyone brave enough to dive into treating adol...For anyone brave enough to dive into treating adolescent migraiwne and headache, this trial comes as a severe disappointment. As pediatric providers, we often lament the lack of randomized trial evidence in children, and it is both disappointing and sobering that the two drugs suggested by experts and previous trials to offer the best opportunity for prevention of migraine had so little effect.<br /><br />On the positive side, the notable placebo effect, regression to the mean over time, or true improvement over time (just three of the potential competing hypotheses to explain the lack of differences) offer some hope for patients and providers. In an accompanying editorial, Jackson commented that the marked placebo response rate in this study is commonly seen in headache trials.<br /><br />Jackson also offers some good advice for how to respond to these findings. Rather than providers taking the approach that "nothing works," we should focus on working with patients on nonpharmacologic approaches; being a supportive medical source; and considering use of less potentially problematic medications, such as acetaminophen or ibuprofen, as prophylaxis. Of course, the data available for nonpharmacologic approaches to preventing headache are also woefully thin, and long-term use of ibuprofen or acetaminophen poses problems. However, focusing on hope for improvement is an important aspect of treatment and appears to be a reasonable expectation for both patients and providers.<br /><br />http://www.medscape.com/viewarticle/875272?<br />Galen Breningstall, MDhttps://www.blogger.com/profile/07170864203251456228noreply@blogger.com