Paediatrica Indonesiana
VOLUME 49 September NUMBER 5
Original Article
Effectiveness of cyproheptadine in the prevention of childhood migraine
Zulkarnain, Johannes Saing, Yazid Dimyati, Bistok Saing
Abstract Background Migraine is one of the causes of recurrent headache eadache, more particularly migraine, is a LQFKLOGKRRG&\SURKHSWDGLQHLVZHOONQRZQDVDQDQWLKLVWDPLQH frequent health problem in children and but there are few studies revealing the drug’s effect in pediatric migraine. DGROHVFHQWV+HDGDFKHVDUHHVWLPDWHGWR Objective To determine the effectiveness of cyproheptadine in the EHRFFXUUHGLQXSWRRIDGROHVFHQWV prophylactic treatment of childhood migraine. +DQGRI\RXQJHUFKLOGUHQ0LJUDLQHKDVWKHJUHDWHVW Methods$UDQGRPL]HGSODFHERFRQWUROOHGFOLQLFDOWULDOVWXG\ impact on children and parents. It occurs in up to was performed at Medan. One hundred children with migraine DFFRUGLQJWRWKH,QWHUQDWLRQDO+HDGDFKH6RFLHW\FULWHULDZHUH FKLOGUHQZLWKDJHEHWZHHQDQG\HDUVDQG 1 LQFOXGHGLQWKHVWXG\6XEMHFWVZHUHGLYLGHGLQWRWZRJURXSVDQG LQFKLOGUHQDJHGWR \HDUV Although the HDFKJURXSZDVJLYHQHLWKHUPJF\SURKHSWDGLQHRUSODFHERIRU DWWDFNVRIPLJUDLQHPD\VWDUWDWDQ\DJHWKHLQFLGHQFH ZHHNV+HDGDFKHIUHTXHQF\ZDVPHDVXUHGLQKHDGDFKHGD\VSHU SHDNVLQHDUO\WRPLGDGROHVFHQFHMigraine, as month, duration was measured in hours and functional disability defined by the research group on headache of the ZDVPHDVXUHGE\3HGLDWULF0LJUDLQH'LVDELOLW\$VVHVVPHQW 3HG0,'$6 7KHHIILFDF\ZDVPHDVXUHGEHIRUHLQWHUYHQWLRQ World Federation of Neurology, is a familial disorder DOVRDQGPRQWKVDIWHULQWHUYHQWLRQ FKDUDFWHUL]HGE\UHFXUUHQWDWWDFNVRIKHDGDFKH Results$WRWDORISDWLHQWVZLWKDJHUDQJLQJIURPWR\HDUV widely variable in intensity, frequency, and duration. ROG ZLWKPHDQ\HDUV ZHUHWUHDWHGZLWKF\SURKHSWDGLQH $WWDFNVDUHXVXDOO\XQLODWHUDODQGDUHDVVRFLDWHGZLWK RUSODFHERIRUKHDGDFKH&RPSDUHGWREDVHOLQHWKHUHZDVD anorexia, nausea and vomiting. In some cases, these VLJQLILFDQWGLIIHUHQFHRQ3HG0,'$6JUDGLQJRIPLJUDLQHVLQERWK JURXSV 3 +HDGDFKHIUHTXHQF\DQGGXUDWLRQSHUPRQWK DUHSUHFHGHGE\ RUDVVRFLDWHGZLWK QHXURORJLFDODQG were significantly different after treatment with cyproheptadine mood disturbances.3 7KH:RUOG+HDOWK2UJDQL]DWLRQ 3 &,WRDQG3 &, WR55 FRPSDUHGWRSODFHERJURXS 3! EXW WKHUHZHUHVLGHHIIHFWVRIF\SURKHSWDGLQHXSWR Conclusion&\SURKHSWDGLQHDSSHDUVWREHHIIHFWLYHDVDQ alternative prophylactic treatment of childhood migraine. Presented at the 14th,QGRQHVLDQ&RQJUHVVRI3HGLDWULFV,QGRQHVLDQ +RZHYHUSHGLDWULFLDQVVKRXOGFRQVLGHUWKHVLJQLILFDQWVLGHHIIHFWV 3HGLDWULF6RFLHW\6XUDED\D-XO\th th of this drug. [Paediatr Indones. 2009;49:286-91]. )URPWKH'HSDUWPHQWRI&KLOG+HDOWK0HGLFDO6FKRRO8QLYHUVLW\RI North Sumatera, Medan, Indonesia. Keywords: cyproheptadine, prophylaxis, childhood migraine Reprint request to: =XONDUQDLQ0''HSDUWPHQWRI&KLOG+HDOWK 0HGLFDO6FKRRO8QLYHUVLW\RI1RUWK6XPDWHUD-O%XQJD/DX1R 0HGDQ,QGRQHVLD7HO)D[ (PDLO [email protected]
286Paediatr Indones, Vol. 49, No. 5, September 2009 Zulkarnain et al:&\SURKHSWDGLQHLQSUHYHQWLQJPLJUDLQH
:+2 FRQVLGHUVWKDWVHYHUHPLJUDLQHFDQEHDV VXEMHFWVZHUHWKHIROORZLQJ RQHRIWKHFULWHULDVXFKDV disabling as quadriplegia.4,5 WZRRUPRUHDWWDFNVSHUPRQWKWKDWSURGXFHGLVDELOLW\ Approach to migraine treatment involves acute ODVWLQJRUPRUHGD\VSHUPRQWK FRQWUDLQGLFDWLRQ DERUWLYH DQGSUHYHQWLYH SURSK\ODFWLF 3UHYHQWLYH WRRUIDLOXUHRIDFXWHWUHDWPHQWV WKHXVHRIDERUWLYH WUHDWPHQWJLYHQHYHQLQWKHDEVHQFHRIDWWDFNVLV PHGLFDWLRQPRUHWKDQWZLFHSHUZHHN DQGWKH aiming to reduce the frequency and severity of the presence of uncommon migraine conditions including PLJUDLQHDWWDFNPDNHDFXWHDWWDFNVPRUHUHVSRQVLYH hemiplegics migraine, migraine with prolonged aura, to abortive therapy, and perhaps also improve the or migraines infarction. We excluded patients from patient’s quality of life.On average, two thirds WKHVWXG\LQWKHSUHVHQFHRIDQ\RIWKHIROORZLQJ RISDWLHQWVZLOOKDYHUHGXFWLRQLQKHDGDFKH FKURQLFGDLO\KHDGDFKHV PRUHWKDQRQHW\SHRI frequency with most preventive drugs.4 Many clinical KHDGDFKHLQFOXGLQJFOXVWHUKHDGDFKHV FRH[LVWLQJ trials in children using expensive drugs such as sodium PHGLFDOQHXURORJLFDORUSV\FKLDWULFGLVRUGHU SUHYLRXV valproate and topiramate show good outcome. treatment with three or more migraine prophylactic &\SURKHSWDGLQHKDVDORZFRVWVRPHWLPHVLWLVXVHG PHGLFDWLRQV KLVWRU\RISUHYLRXVF\SURKHSWDGLQHXVH by pediatric neurologist, however only Rao et al who history of noncompliance with previous migraine had studied this drug compared with other drug. medications and obesity. Migraine is a common cause of headache in children 7KHVWXG\ZDVDSSURYHGE\WKH(WKLFV&RPPLWWHH and it significantly reduces school attendances, but of University of North Sumatera. As part of the not may has studied about the phenomenon. We standard assessment, detailed questionnaires at initial compared cyproheptadine with placebo to determine DQGIROORZXSHYDOXDWLRQVZHUHREWDLQHG7KLV their effectiveness in prophylactic treatment of questionnaire included information about headache childhood migraine. frequency, duration, and characteristics, as well as some general health screening, documentation of school absences, and ratings of functioning at home Methods and school. Frequency was measured in headache days per month, duration was measured in hours, This was a randomized clinical trial with control and functional disability was measured by Pediatric SODFHERVWXG\&RQGXFWHGIURP)HEUXDU\WR0D\ 0LJUDLQH'LVDELOLW\$VVHVVPHQW6FDOH 3HG0,'$6 6XEMHFWVZHUHUHFUXLWHGIURPHOHYHQVFKRROV 3HGLDWULF0LJUDLQH'LVDELOLW\$VVHVVPHQW LQFOXGLQJWKUHHMXQLRUKLJKVFKRROVDQGHLJKWVHQLRU 3HG0,'$6 ZDVDGPLQLVWHUHGWRDOORIWKHSDWLHQWV high schools in Medan, North Sumatera. For each DVSDUWRIWKLVTXHVWLRQQDLUHDWLQLWLDODQGIROORZXS GLVRUGHUDVHULHVRIGHWDLOHGSULPDULO\\HVQRTXHVWLRQV HYDOXDWLRQV3HG0,'$6ZDVDVL[LWHPTXHVWLRQQDLUH ZHUHDVNHG(DFKVXEMHFWZDVDVNHG ´+DYH\RXHYHU The initial three questions dealt with impact of had a lot of trouble with headaches?”, if they had a KHDGDFKHRQVFKRRO TXHVWLRQDVNHGDERXWVFKRRO SRVLWLYHUHVSRQVHWKHQWKH\ZHUHDVNHGLIWKH\WRRN GD\DEVHQFHV TXHVWLRQDVNHGDERXWSDUWLDOGD\ medication for the headaches and how recently DEVHQFHV DQGTXHVWLRQDVNHGDERXWIXQFWLRQLQJ the headache occurred. A positive response to this DWRUOHVVDELOLW\LQVFKRRO7KHIRXUWKTXHVWLRQ general headache question was used as a nonspecific, assesed the impact due to headache at home and VHQVLWLYHVFUHHQLQJTXHVWLRQWRHVWDEOLVKWKHDWULVN LQFOXGHGLQDELOLW\WRSHUIRUPKRPHZRUNDQGFKRUHV VWXG\VXEMHFWVWRHVWLPDWHWKHLQFLGHQFHRIPLJUDLQH The final two questions assesed disability in social LQWKHVWXG\VXEMHFWVRQIROORZXS IXQFWLRQLQJLQFOXGLQJVSRUWV TXHVWLRQDVNHGDERXW 0LJUDLQHZDVGLDJQRVHGE\FRQVXOWDQWSHGLDWULF FRPSOHWHDEVHQFHIURPDFWLYLWLHVZKLOHTXHVWLRQ neurologist in accordance with The International DVNHGDERXWIXQFWLRQLQJDWRUOHVVRIWKHLUDELOLW\ +HDGDFKH6RFLHW\ ,+6 FULWHULD:HLQFOXGHGDOO 3HG0,'$6ZHUHDVNHGDIWHUFRPSOHWLRQWRUDWHWKHLU VWXGHQWVGLDJQRVHGZLWKPLJUDLQHDFFRUGLQJWR,+6 overall disability due to headache in the preceding 3 ZKRVHDJHUDQJLQJIURPWR\HDUVDQGZKRKDG PRQWKV JOREDOUDWLQJ WKHSDWLHQWVZHUHSURPSWHG experienced migraine. Informed consent was obtained with the choices of none to little, mild, moderate, and from the parents. The selection criteria for study severe. Responses to this question were obtained prior
Paediatr Indones, Vol. 49, No. 5, September 2009287 Zulkarnain et al:&\SURKHSWDGLQHLQSUHYHQWLQJPLJUDLQH
WRGLVFXVVLQJ3HG0,'$6VFRUHVDQGWKHLUVLJQLILFDQFH ZHUHUDQGRPO\GLYLGHGLQWRWZRJURXSV FKLOGUHQ ZLWKWKHSDWLHQWV0HDQ3HG0,'$6VFRUHVZLWK LQWKHWUHDWPHQWJURXSZLWKF\SURKHSWDGLQHDQG standard deviations were determined for each of the FKLOGUHQLQSODFHERJURXS'XULQJWKHIROORZXSWKH four global rating responses. second months, there were two dropouts from the 6XEMHFWVZHUHUDQGRPL]HGLQWRWZRJURXSVXVLQJ treatment group. The intention to treat analysis was simple randomization method. Anthropometric data SHUIRUPHGRQDOOVXEMHFWVXQWLOWKHHQGRIVWXG\DIWHU was recorded including body weight and the height. 3 months. )LUVWJURXS $ UHFHLYHGF\SURKHSWDGLQHPJGD\ From the questionnaires and physical examination RQFHGDLO\GXULQJEHGWLPH7KHVHFRQGJURXS % before intervention, there were no significant received placebo containing saccharum lactis once GLIIHUHQFHVRQVXEMHFWV·FKDUDFWHULVWLFEHWZHHQWKH GDLO\GXULQJEHGWLPHDQGUHTXHVWHGWRWDNHLWLQWKH WZRJURXSV Table 1 6L[W\WZR RISDWLHQW VDPHPDQQHUDVWKHF\SURKHSWDGLQH6XEMHFWVGLGQRW had a clinical diagnosis of migraine without aura, NQRZZKHWKHUWKHFDSVXOHFRQWDLQHGF\SURKHSWDGLQH DQG KDGPLJUDLQHZLWKDXUD2IWKHVH or placebo, both groups got therapy for 3 months. All SDWLHQWVVXEMHFWVZHUHPDOHDQGZHUHIHPDOH VXEMHFWVZHUHUHDVVHVVHGDIWHUPRQWKIRUWZRJURXS·V 7KHPHDQ3HG0,'$6UDZVFRUHZDVIRUHDFKJOREDO F\SURKHSWDGLQHRUSODFHER$WWKHIROORZXSYLVLW rating category for the total group, the initial group frequency and duration of headaches were determined DQGWKHIROORZXSJURXS%DVHGRQWKHFRQYHUJHQFH for the preceding 4 ZHHNVDQGKHDGDFKHVFRUHVIURP RISDWLHQWJOREDOUDWLQJVZLWK3HG0,'$6UDZVFRUH daily diaries were calculated at monthly intervals. D3HG0,'$6JUDGLQJV\VWHPZDVGHYHORSHG8VLQJD All headache diaries were filled in by the SULQFLSOHRIQRQRYHUODSSLQJZHUDQJHGWKHVFRUHVWR children. After the third month’s treatment, each JUDGH, OLWWOHWRQRQHDQGPLOGGLVDELOLW\ *UDGH FKLOGZDVDVNHGWRLQGLFDWHWKHSUHIHUUHGWUHDWPHQW ,, PRGHUDWHDQGVHYHUHGLVDELOLW\ ! in the diary. The code was opened for the treatment Migraine frequency in cyproheptadine group only, because it was considered ethically unacceptable Table 2 GHFUHDVHGIURP 6' WR 6' to withhold adequate treatment until the whole trial 3 &, WR ZKLOHLQ ZDVFRPSOHWHG&KLOGUHQZHUHDVNHGWRUHSRUWDQ\ placebo group, the frequency was only decreased from DGYHUVHHYHQWVGXULQJWKHIROORZXSYLVLWVDQGLQWKH 6' WR 6' 3 &, KHDGDFKHGLDULHV'LDULHVZHUHFROOHFWHGZKHQWKH WR 3HG0,'$6VFRUHVREWDLQHGDWWKH WHVWVZHUHFRPSOHWHG&KLOGUHQZKRKDGQRWUHSOLHG LQLWLDODQGIROORZXSRIERWKJURXSVDUHFRPSDUDEOH were contacted by phone. 'DWDZDVDQDO\]HGXVLQJ3HDUVRQFKLVTXDUH Tabel 1. Baseline characteristics of migraine WWHVW0DQQ:KLWQH\8WHVW:LOFR[RQUDQNVWHVW Characteristic Cyproheptadine Placebo and also intention to treat analysis. The value 95% (n=52) (n=48) &,DQGYDOXHVRI3 ZHUHFRQVLGHUHGWREH Age, mean (SD), years 14.7 (1.77) 15.2 (19.66) statistically significant. Sex, n (%) Male 10 (20.0) 8 (16.0) Female 40 (80.0) 42 (84.0) Body weight, mean (SD), kg 46.3 (7.11) 48.3 (7.26) Results Trigger by foods, n (%) No 12 (24.0) 19 (38.0) Yes 38 (76.0) 31 (62.0) )URPVFKRROVLQFOXGLQJWKUHHMXQLRUKLJKVFKRROV Migraine, n (%) and eight senior high schools in Medan, North Without aura 30 (60.0) 32 (64.0) Sumatera, we searched for childhood migraine With aura 20 (40.0) 18 (36.0) Frequency 5.5 (3.62) 4.9 (2.96) FDQGLGDWHV2IWKHFKLOGUHQVFUHHQLQJWKHUH Duration, n (%) ZHUHZLWKFKURQLFKHDGDFKH PHW,+6 1-2 hours 37 (71.2) 36 (75.0) GLDJQRVWLFFULWHULDIRUPLJUDLQH7KHUHZHUH > 2 hours 15 (28.8) 12 (25.0) PedMIDAS, mean (SD) 19.5 (11.55) 16.9 (9.19) SDWLHQWVHOLJLEOHIRUHQUROOPHQWGXULQJWKHSUH PedMIDAS grading, n (%) specified dates and times of the study, however only 0 - 30 45 (86.5) 45 (93.8) SDWLHQWVZHUHSDUWLFLSDWHGLQWKLVVWXG\7KH\ > 31 7 (13.5) 3 (6.3)
288Paediatr Indones, Vol. 49, No. 5, September 2009 Zulkarnain et al:&\SURKHSWDGLQHLQSUHYHQWLQJPLJUDLQH
Table 2. Outcome severity and frequency each groups before and after treatment Cyproheptadine Placebo Parameter Mean (SD) P 95% CI Mean (SD) P 95% CI Frequency Before 5.6(3.64) 4.9(2.96) After 3.4(2.57) 0.001 1.359 to 3.001 4.7(2.69) 0.286 -0.180 to 0.596 PedMIDAS Before 19.5(11.50) 16.9(9.19) After 12.7(8.90) 0.001 5.202 to 8.398 16.1(9.38) 0.038 0.049 to 1.617
Table 3. Comparison of cyproheptadine with placebo after three months of intervention Parameter Cyproheptadine Placebo P 95% CI Frequency, Mean (SD) 3rd Month 3.4 (2.57) 4.7 (2.69) 0.009 (0.000 to 0.030) PedMIDAS 50 (40.61) 48 (58.76) 0.001 (0.000 to 0.030) Duration, n (%) 3rd month 1 – 2 hours 49 (98) 41 (85.4) RR 4.36 > 2 hours 1 (2) 7 (14.6) 0.029 (0.690 to 27.510) PedMIDAS grading,n (%) 0 - 30 48 (96.0) 45 (93.8) RR 1.29 > 31 2 (4) 3 (6.3) 0.674 (0.433 to 3.843) Side Effects, n (%) No 14 (26.9) 32 (66.7) 0.001 (-0.510 to -0.130) Yes 38 (73.1) 16 (33.3)
)RUWKHIROORZXSJURXSRIF\SURKHSWDGLQHWKH 3HG0,'$6VFRUHKDGLPSURYHGWR 6' in deciding whether acute or prophylactic treatments IURP 6' DWLQLWLDOSUHVHQWDWLRQ 3 are the most effective in children. The treatments that ZLWK &,WR ZKLOHLQSODFHERJURXS ZRUNEHVWIRUDGXOWVPD\QRWEHEHVWIRUFKLOGUHQ9 WKH3HG0,'$6VFRUHKDGLPSURYHGWR 6' $EX$UHIHKDQG5XVVHO reported migraine was a IURP 6' DWLQLWLDOSUHVHQWDWLRQ 3 common cause of headache in children and causes ZLWK &, WR significantly reduced school attendance. The study 7KHUHVXOWRIF\SURKHSWDGLQHJURXS Table 3) showed that migraine prevalence in students was still compared with placebo were significant, frequency KLJKDWOHDVWLQFKLOGUHQDJHGWR\HDUV 3 &,WR GXUDWLRQ3 This study also demonstrated that the disability grade 55 &, WR DQG3HG0,'$6 FRXOGEHWUDFNHGGXULQJWUHDWPHQW:HXVHGGDLO\ VFRUH3 &,WR 7KHPHDQ KHDGDFKHGLDULHVDQG3HG0,'$69LVXGWLEKDQ 3 month migraine frequency was reduced by 3.4 SHUIRUPHGDFURVVVHFWLRQDOVWXG\WRGHWHUPLQHWKH 6' LQSDWLHQWVUHFHLYLQJF\SURKHSWDGLQHDV prevalence of migraine in seventh grade Thai student FRPSDUHGZLWK LQSDWLHQWUHFHLYLQJSODFHER LQIRXUMXQLRUKLJKVFKRROVLQ%DQJNRN7KDLODQG$OO Adverse experience or side effects in cyproheptadine RI VWXGHQWVLQSDUWLFLSDWLQJVFKRROVFRPSOHWHG group were especially sleepy and increased appetite, WKHTXHVWLRQQDLUH$IWHUWZRLQWHUYLHZVVWXGHQWV DVPXFKDVLQ FRPSDUHGZLWKSODFHER ZHUHGLDJQRVHGZLWKPLJUDLQH RQO\ Preventive treatment in population of children who have frequent, disabling migraine is the most efficacious agent, but encouraging data are emerging Discussion regarding topiramate and sodium valproate as well as the cyproheptadine.&XUUHQWO\QRPHGLFDWLRQV Pediatric migraine is a common problem that warrants is approved by the )RRGDQG'UXJ$GPLQLVWUDWLRQ greater attention. There is little information to rely on for prophylaxis of migraines in children. Seventeen
Paediatr Indones, Vol. 49, No. 5, September 2009289 Zulkarnain et al:&\SURKHSWDGLQHLQSUHYHQWLQJPLJUDLQH drugs were identified and included in the review. Of VHGDWLRQDQGRULQFUHDVHGDSSHWLWHYV the drugs with available data are topiramate, valproic cyproheptadine group compared to placebo. Rao et acid, flunarizine, amitriptyline, and cyproheptadine al reported cyproheptadine alone had improved the have shownefficacy in decreasing migraine frequency frequency, duration and severity significantly but side and duration in children. effects were more than in the combination group &\SURKHSWDGLQHZLWKERWKDQWLVHURWRQHUJLF F\SURKHSWDGLQHDQGSURSUDQRORO DQGFDOFLXPFKDQQHOEORFNHUDFWLYLWLHVKDVQRWEHHQ Finally, the patient must understand that VXEMHFWHGWRULJRURXVVWXG\KRZHYHULWKDVEHHQ prophylactic therapy will not completely eliminate widely adopted for migraine prevention in children. headache occurrence. The goal of prophylactic therapy Effective doses for migraine prevention may be lower is to decrease headache frequency and severity while than doses used for other conditions. For example, the possibly improving patient response to acute therapies. DQWLGHSUHVVDQWGRVHRIDPLWULSW\OLQHLVPJWR To conclude, our results indicate that cyproheptadine mg per day, while the dose for migraine prevention appears to be effective as alternative prophylactic LVXVXDOO\PJGD\'RVLQJUHJLPHQVYDU\ treatment of childhood migraine, but its frequent ZLGHO\IURPVLQJOHEHGWLPHVFKHGXOHVWRWZLFHGDLO\ and significant side effects need consideration when UHJLPHQV$GRVHRIWRPJRUDOO\DWEHGWLPHLVD administering the drug. rational starting point.The findings confirm that, DWDGRVHRIPJGD\F\SURKHSWDGLQHLVDQHIIHFWLYH and well tolerated drug for migraine prevention. The References WKHUDSHXWLFHIIHFWZDVFRQVLVWHQWGHFUHDVHGVXEMHFWV in cyproheptadine group were dropped out. +HUVKH\$':LQQHU3.3HGLDWULFPLJUDLQH UHFRJQLWLRQ 7KHFDXVHRIPLJUDLQHLVXQNQRZQDQGWKHUHDUH DQGWUHDWPHQW-$2 IHZUHOLDEOHGDWDWKDWKDYHLGHQWLILHGULVNIDFWRUVRU *RDGVE\3-/LSWRQ5%)HUUDUL0'0LJUDLQH²FXUUHQW quantified their effects in children. A family history XQGHUVWDQGLQJDQGWUHDWPHQW1(QJO-0HG is common. Proposed precipitants in genetically predisposed children and adolescents include hunger, /D]XDUGL61\HULNHSDODSDGDDQDNGDQUHPDMD,Q IDVWLQJPHQVHVH[HUFLVHVWUHVV IRUH[DPSOHVOHHS 6RHWRPHQJJROR76,VPDHO6HGLWRUV%XNXDMDUQHXURORJL GHSULYDWLRQ DQGIRRGV IRUH[DPSOHFKRFRODWH 19 DQDNQGHG-DNDUWD %DODL3HQHUELW,'$, S 2XUVXEMHFWVPD\EHSURSRVHGE\IRRG *RDGVE\3-5HFHQWDGYDQFHVLQWKHGLDJQRVLVDQG including coffee, chocolate, meat, and noodle. PDQDJHPHQWRIPLJUDLQH%0- Migraine frequency in our study were decreased *RDGVE\3-/LSWRQ5%)HUUDUL0'0LJUDLQH²FXUUHQW IURP 6' WR 6' ZKLOH3HG0,'$6 XQGHUVWDQGLQJDQGWUHDWPHQW1(QJO-0HG VFRUHZHUHDOVRGHFUHDVHGIURP WR 2WKHUVWXGLHVXVLQJWRSLUDPDWHDQGVRGLXP 5RWKQHU'0HQNHV-++HDGDFKHVDQGQRQHSLOHSWLFHSLVRGLF valproate in children showed similar results.The GLVRUGHUV,Q 0HQNHV-+HGLWRUV&KLOG1HXURORJ\WKHG 3HG0,'$6TXHVWLRQQDLUHSURYLGHGDGHYHORSPHQWDOO\ 3KLODGHOSKLD /LSSLQFRWW:LOOLDPV :LONLQV sensitive, reliable, and valid assessment of the disability of childhood and adolescent headaches. 5DR%6'DV'*7DUDNQDWK956DUPD<$GRXEOHEOLQG 7KH3HG0,'$6·FULWHULDYDOLGLW\VXSSRUWVLWVUROHDV controlled study of propranolol and cyproheptadine in a component of assessing the impact of headaches on PLJUDLQHSURSK\OD[LV1HXURO,QGLD DFKLOGCVOLIH3HG0,'$6UHODWHVWRVFKRRODQGKRPH $EX$UHIHK,5XVVHO*3UHYDOHQFHRIKHDGDFKHDQGPLJUDLQH IXQFWLRQDODELOLW\+HUVKH\DQG:LQQHU1 reported LQVFKRROFKLOGUHQ%0- children in their study showed a mean reduction %ODQG6(3HGLDWULFPLJUDLQHUHFRJQLWLRQPDQDJHPHQW-RXUQDO RISRLQWVLQWKHLU3HG0,'$6VFRUHLQGLFDWLQJ RIWKH3KDUPDF\6RFLHW\RI:LVFRQVLQ a reduction of nearly half of their disability due to 9LVXGWLEKDQ$0LJUDLQHLQ7KDLFKLOGUHQ 3UHYDOHQFHLQ headaches with treatment.,QWKLVVWXG\RQO\ MXQLRUKLJKVFKRROVWXGHQWV-&KLOG1HXURO points of showed a mean reduction. In our study, we found side effects, including /HZLV':3UHYHQWLYHWKHUDS\IRUPLJUDLQH,Q 0DULD%/
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divalproex sodium in the prophylactic treatment of children ZLWKPLJUDLQH+HDGDFKH 'RQDOG:/HZLV0'3HGLDWULF0LJUDLQH3HGLDWU5HY +HUVH\$'3RZHUV6:9RFNHOO$//H&DWHV6.DEERXFKH M. Effectiveness of topiramate in the prevention of childhood /HZLV':$VKZDO6'DKO*3UDFWLFHSDUDPHWHU (YDOXDWLRQ KHDGDFKHV+HDGDFKH of children and adolescents with recurrent headaches. AAN. +HUVKH\$'3RZHUV6:9RFNHOO%/H&DWHV6.DEERXFKH 0$ 0D\QDUG 0. 3HG0,'$6 GHYHORSPHQW RI D )LODQG/6-HQNLQV/63HGLDWULF0LJUDLQH 3KDUPDFRORJLF questionnaire to assess disability of migraines in children. DJHQWVIRUSURSK\OD[LV$QQ3KDUPDFRWKHU 1HXURORJ\ +HUVKH\$'3RZHUV6:9RFNHOO$/%/H&DWHV6/6HJHUV *XQQHU.%6PLWK+')HUJXVRQ/(3UDFWLFHJXLGHOLQH $.DEERXFKH0$'HYHORSPHQWRIDSDWLHQWEDVHGJUDGLQJ for diagnosis and management of migraine headaches in VFDOHIRU3HG0,'$6&HSKDOJLD
Paediatr Indones, Vol. 49, No. 5, September 2009291