SUMATRIPTAN FOR MIGRAINE ATTACKS IN CHILDREN - A RANDOMIZED PLACEBO-CONTROLLED STUDY - DO CHILDREN WITH MIGRAINE RESPOND TO ORAL SUMATRIPTAN DIFFERENTLY FROM ADULTS

Oral sumatriptan is an effective acute treatment for migraine in adult s, but its efficacy in children is still undetermined. Twenty-three ch ildren, aged 8.3 to 16.4 years, took both sumatriptan and placebo in a randomized, double-blind, placebo-controlled, crossover trial. The pr imary endpoint was a greater than or equal to 50% decrease in pain int ensity on a 100-mm visual analogue scale at 2 hours. Other endpoints o f efficacy were pain intensity difference (PID), showing pain relief a t each time point; summed pain intensity differences (SPIDs), estimati ng overall pain relief; and preference. Two hours after sumatriptan, 7 of 23 reached the primary endpoint, and after placebo, 5 of 23 (diffe rence 9%, 95% CI for difference, -21 to 38%; p = ns). Within 2 hours, the headache disappeared completely in 5 of 23 children after sumatrip tan and in 2 of 23 children after placebo (p = ns). Median PIDs were s lightly better for sumatriptan between 0.5 and 4 hours (p = ns). Media n SPIDs increased almost identically up to 2 hours. Thereafter, median SPIDs for placebo remained practically constant, whereas for sumatrip tan, the improvement continued. At 4 hours, the median SPID for sumatr iptan was 2.4 times as high as for placebo. However, the maximum diffe rences between median SPIDs at 4 hours (38.5, 95% CI, -75.8 to 57.5; W ilcoxon signed rank test, p = 0.4) or at any other point were not stat istically significant. Of the 23 children, 13 preferred sumatriptan an d 2 placebo (sign test, p = 0.004). The failure of this and previous c ontrolled studies suggests that the response of children to sumatripta n may be different from adults.