Nonpharmacologic Treatment of Migraine With Low-Dose Propranolol or Amitriptyline
Pediatric Neurology , 06/19/2012

Eidlitz–Markus T et al. – Propranolol is preferred because of its lower risk of side effects. An additive effect of nonpharmacologic measures may allow for a reduction in drug dose.

• Data were collected from the medical files of 118 patients (mean age, 12.54 ± 3.14 years S.D.).
• All were treated with nonpharmacologic measures.
• In addition, 93 children received propranolol (mean initial dose, 0.4 ± 0.17 mg/kg/day S.D.), and 25 received amitriptyline (mean initial dose, 0.26 ± 0.1 mg/kg/day S.D.).
• Twenty patients were switched from propranolol to amitriptyline during treatment.

• In both groups, headache frequency was reduced by >50% per month in 80% of patients.
• Patients without aura responded significantly better to propranolol than patients with aura (P=0.02).
• No significant difference was evident in response to pharmacologic treatment by migraine frequency or type (episodic chronic).
• No significant difference was evident in response to amitriptyline between patients with or without aura.
• The response rate was higher than previously reported for placebo.
• Low-dose propranolol and low-dose amitriptyline, when combined with nonpharmacologic measures, are equally effective in reducing the frequency of migraine in children.