Once again you find yourself in a busy general paediatric clinic faced with a 14 year old girl suffering from recurrent headaches for the past nine months. The history would suggest frequent attacks of a migrainous nature without aura. There is a positive family history in both parents and a sibling, but no obvious precipitating factors. The attacks are now occurring weekly and interfering with normal activities, especially school attendance. She is due to start GCSE coursework soon and both her and her parents are very keen to try a preventative medication. Her neurological examination is normal. They would like her on pizotifen or propranolol as these have helped other family members in the past. She is not asthmatic and otherwise healthy.

Structured clinical question

In an adolescent with frequent migrainous headache [patient] does the prescription of pizotifen or propranolol [intervention] reduce the frequency and/or …