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You are a paediatric neurology registrar conducting a neurology clinic. You see a 12-year-old girl with frequent episodes of migraine. She has been prescribed propranolol and pizotefin in the past, with no significant benefit. Recently, the frequency and severity of headaches have increased. The family wonders if she can be put on some other medication. You have heard that topiramate is increasingly being used as a preventive treatment in adults with chronic migraine. However, you are not sure if there is enough evidence to justify its use in the paediatric age group. You decide to examine the evidence.
Structured clinical question
In children with chronic migraine [population], does regular treatment with topiramate [intervention] reduce the severity and frequency of headaches [outcome]?
Search strategy and outcome
MEDLINE and Embase (1974–September 2009) were searched via the OVID interface using the keywords ‘Topiramate’ and ‘Migraine’, limited to Human, English.
Three double-blind randomised placebo controlled studies, one double-blind dose comparison study and one subset analysis from a double-blind placebo controlled study were found. All are included in the analysis here (see table 3). Three open level studies, five evidence based reviews without meta-analysis and a few retrospective case series were also found. None …