Anticonvulsant Use for Prophylaxis of the Pediatric Migraine

Lea S. Eiland, PharmD, BCPS; Teri Woo, PhD(c), MS, RN, CPNP; Elizabeth Farrington, PharmD, FCCP, BCPS

Disclosures

J Pediatr Health Care. 2007;21(6):392-395. 

In This Article

Levetiracetam

Levetiracetam has been evaluated in three small studies for migraine prophylaxis. Nineteen children (aged 3-17 years) were included in one retrospective review (Miller, 2004). Eleven of these children previously had used other prophylaxis medications. Mean headache frequency decreased from 6.3 to 1.7 per month (P < .0001). Ten patients became headache free. Seven others experienced improvement with levetiracetam; however, two patients found no benefit. Secondary symptoms such as nausea and vomiting completely disappeared in seven patients. Doses ranged from 125 to 750 mg twice daily, and mean duration of therapy was 4.1 months. Three patients experienced adverse effects with therapy. One patient had asthenia, somnolence, and dizziness, and another became irritable, hyperactive, and hostile. The third patient had irritability and moodiness. Only two of these patients discontinued therapy because of adverse effects.

One open-label monotherapy trial included 30 patients (aged 6-19 years) who had at least two migraines per week (Vaisleib, Neft, & Schor, 2005). After 10 weeks, 19 patients completed the study. Six of these patients had a greater than 50% decrease in migraine frequency and severity. Eight patients had a greater than 75% decrease in both, and three patients were headache free. Only two patients experienced worse headaches while taking levetiracetam. The PedMIDAS score decreased by more than 75% in 15 patients. One patient experienced violent behavior and delusions and thus withdrew from the trial. Ten others withdrew because of noncompliance, lack of efficacy, or seizure disorder.

A smaller study retrospectively evaluated 15 patients (aged 11-19.5 years) for whom levetiracetam was prescribed for chronic headaches (DeSouza, Shahid, & Waren). The majority of the patients (73%) experienced migraines. During a 6-week period, mean headache frequency decreased from 16.8 to 1.5. Ten patients responded with significant improvement, and two patients became headache free. Doses were initiated at 250 mg twice daily and titrated. The final average dose was 660 mg/day, with a range of 500 to 1500 mg/day. One patient, however, did not find benefit from levetiracetam, and one patient experienced more headaches on therapy. Four patients experienced fatigue, dizziness, and mood swings.

These three small trials show initial benefit with levetiracetam for migraine prophylaxis in children; however, several patients experienced adverse effects or withdrew from the study because of noncompliance. Larger studies with stronger designs are needed to fully evaluate the benefit of levetiracetam in this population.

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