Sunday, March 03, 2013

Prescription Medications for Children’s Headache Are Generally No Better than Placebo

Similar to adults, headache is one of the most common symptoms that children (including adolescents) report. Patients are often treated with numerous trials of medications to reduce headaches. Many times, they report that none of the medications have helped. Although some patients report reduced headache after using prescription medicine, this does not mean that the medicinal powers of the medication actually caused the reduction. That is, the improvement may have been due to the placebo effect.

The placebo effect is when someone reports or shows improvement in a health condition when given a treatment they are told is genuine but is actually not. An example would be telling one group of patients that they are being given a medication to treat headaches when they are only swallowing a sugar pill that does not actually treat headaches. In this example, the sugar pill is known as a placebo. If the placebo group reported significant improvement from the sugar pill treatment then this improvement is known as the placebo effect.

If drug studies do not include a placebo group for comparison purposes then there is no way to tell if any reported improvements from genuine medical treatments are due to actual medicinal effects or due to the powers of suggestion (placebo effect). When studies include a placebo group it is known as a placebo-controlled study.

Unlike placebo treatments, actual medications have potential side effects. Some parents may not want to run the risk of such side effects if the medication prescribed has not been proven to be better than placebo. In an upcoming study to be published in JAMA Pediatrics, researchers reported on the results of statistical analyses based on an extensive literature review to determine the effectiveness of headache medications in reducing headache the frequency and severity of headaches in children (less than age 18). After an literature search revealed 2918 articles for review, only 13 were placebo controlled studies that randomly assigned patients to groups.

The results were startling in that only two medications (topirimate [Topamax] and trazodone) had limited data supporting their effectiveness in treating episodic migraine headaches. Migraines are moderate to severe headaches that are associated with nausea, vision disturbance, vomiting, and light sensitivity. Other commonly used prescription medications for headaches showed no evidence supporting their use in children in adolescents.

What treatment did the study find that was clearly effective at treating headaches? The placebo. The authors noted that since there were so few studies on this topic with placebo comparison groups that more research is needed and that firm conclusions cannot be made at this time. Nevertheless, one is left to wonder whether it would be a good idea for physicians to initially treat children who report headaches with a placebo to see if this works before treating with prescription medication. This is a controversial approach, however, although many physicians use placebo treatments in clinical practice and only a minority view it should be prohibited due to ethical reasons. Note that this study did not review the effects of over the counter pain medications compared to placebo.

Suggested reading: Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain

Related blog entry: The Stomach Bug/Flu in Children: What Works & What Doesn't

Reference: El-Chammas K, Keyes J, Thompson N, Vijayakumar J, Becher D, Jackson JL. (2013). Pharmacologic Treatment of Pediatric Headaches: A Meta-analysis. JAMA Pediatrics.

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