Is Amitriptyline Effective in Reducing Headache Days in Pediatric Patients with Migraines and Chronic Headaches Compared to Topiramate, Propranolol, or No Treatment?

Objective: The objective of this selective EBM review is to determine whether or not “Is amitriptyline effective in reducing headache days in pediatric patients with migraines and chronic headaches compared to topiramate, propranolol, or no treatment?” Study design: Systematic review of two randomized control trials (RCTs) and one case series published in peer-reviewed journals in English after 2007. Data Sources: Two RCTs and one case series were found using PubMed. Outcome(s) Measured: Headache frequency was measured using a headache diary or calendar. A secondary objective included headache severity that was measured using a ten-point scale or the Pediatric Migraine Disability Assessment (PedMIDAS). Results: Powers et al. found that headache frequency did not vary significantly between amitriptyline, topiramate, or placebo.2 It was also recorded that there was no significant variation among reduction in scores on the PedMIDAS.2 Eidlitz-Markus et al. stated that this trial showed no significant difference between amitriptyline and propranolol(p-value=0.8).4 Sezer et al. found that 31% of patients in the topiramate group and 28% of patients in the amitriptyline group “reported freedom from headache.”5 It was also recorded that the severity of headaches also decreased 4.5 points on a visual analog scale in both treatment groups. Conclusions: Amitriptyline in these three trials is less effective in reducing the frequency of chronic headaches and migraines when compared to topiramate, propranolol, or a placebo.2,4,5 These results could be affected by subjectivity, drug adherence, or misunderstanding between younger subjects and their parents. The safety of amitriptyline should always be in question because the FDA warns that antidepressants can cause suicidal thoughts or actions in children under eighteen years old