L-carnitine versus Propranolol for pediatric migraine prophylaxis
Iranian Journal of Child Neurology,
Vol. 15 No. 2 (2021),
1 March 2021
https://doi.org/10.22037/ijcn.v15i2.25558
Abstract
Objective
Carnitine plays a significant role in fatty acid transportation in mitochondria and has been shown to have a prophylactic effect on adult migraine. The aim of this randomized controlled trial was to compare and evaluate the effects of L-carnitine supplementation versus propranolol in the prevention of pediatric migraine.
Materials & Methods
A total of 60 pediatric patients with episodic migraine were randomly allocated to 2 independent groups to receive either 50 mg/kg/day L-carnitine or 1 mg/kg/day propranolol as a prophylactic drug. Frequency, severity, and duration of migraine attacks and headache disability based on the Pediatric Migraine Disability Assessment Score (PedMIDAS) were studied at the baseline and after 2, 4, and 12 weeks.
Results
A total of 56 patients were evaluated in the study: 23 girls (41%) and 33 boys (59%) with a mean age of 9.7 ± 2.1 years. Frequency of migraine headaches per month reduced from 11.4 ± 7.1 to 5.34 ± 2.4 in the L-carnitine group and from 10.7 ± 6.2 to 4.96 ± 3.9 in the propranolol group by the end of the study. Headache severity score was also reduced from 19.38 ± 14 to 2.88 ± 7.4 and from 12.92 ± 13 to 0.82 ± 1.3 in the L-carnitine and propranolol groups, respectively. We found a significant decrease in frequency, severity, and duration of headache attacks in both groups (P < 0.01). No significant difference was observed between the efficacies of the 2 drugs.
Conclusion
This study concluded that L-carnitine supplementation can play a prophylactic role in the management of pediatric migraine.
- Migraine; Pediatrics; Prophylaxis; L-carnitine; Propranolol
How to Cite
References
Teleanu RI, Vladacenco O, Teleanu DM, Epure DA. Treatment of Pediatric Migraine: a Review. Maedica. 2016;11(2):136-43.
Kokavec A. Migraine: A disorder of metabolism? Medical Hypotheses. 2016;97:117-30.
Orr SL, Kabbouche MA, O’Brien HL, Kacperski J, Powers SW, Hershey AD. Paediatric migraine: evidence-based management and future directions. Nature Reviews Neurology. 2018;14(9):515-27.
Gelfand AA, Goadsby PJ. Treatment of Pediatric Migraine in the Emergency Room. Pediatric Neurology. 2012;47(4):233-41.
Wittick L. Evaluation and Management of Headache in the Pediatric Patient. EMERGENCY MEDICINE. 2009.
Powers SW, Coffey CS, Chamberlin LA, Ecklund DJ, Klingner EA, Yankey JW, et al. Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine. New England Journal of Medicine. 2017;376(2):115-24.
Friedman BW. Managing Migraine. Annals of Emergency Medicine. 2017;69(2):202-7.
Galletti F, Cupini LM, Corbelli I, Calabresi P, Sarchielli P. Pathophysiological basis of migraine prophylaxis. Progress in Neurobiology. 2009;89(2):176-92.
Sparaco M, Feleppa M, Lipton RB, Rapoport AM, Bigal ME. Mitochondrial Dysfunction and Migraine. Cephalalgia. 2016;26(4):361-72.
Finsterer J, Zarrouk-Mahjoub S. Headache in mitochondrial disorders. Clinical Neurology and Neurosurgery. 2018;166:44-9.
Vollono C, Primiano G, Della Marca G, Losurdo A, Servidei S. Migraine in mitochondrial disorders: Prevalence and characteristics. Cephalalgia. 2017;38(6):1093-106.
Stuart S, Griffiths LR. A possible role for mitochondrial dysfunction in migraine. Molecular Genetics and Genomics. 2012;287(11-12):837-44.
Montagna P, Sacquegna T, Martinelli P, Cortelli P, Bresolin N, Moggio M, et al. Mitochondrial Abnormalities in Migraine. Preliminary Findings. Headache: The Journal of Head and Face Pain. 1988;28(7):477-80.
Yorns WR, Hardison HH. Mitochondrial Dysfunction in Migraine. Seminars in Pediatric Neurology. 2013;20(3):188-93.
Marfil A. Migraine management. Medicina Universitaria. 2015;17(67):126-30.
Kwok CS, Jackson JL, Kuriyama A, Kuwatsuka Y, Nickoloff S, Storch D, et al. Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis. Plos One. 2019;14(3):e0212785.
Danesh A, Gottschalk PCH. Beta-Blockers for Migraine Prevention: a Review Article. Current Treatment Options in Neurology. 2019;21(4).
Ferroni P, Barbanti P, Della-Morte D, Palmirotta R, Jirillo E, Guadagni F. Redox Mechanisms in Migraine: Novel Therapeutics and Dietary Interventions. Antioxidants & Redox Signaling. 2018;28(12):1144-83.
Roseiro LC, Santos C. Chapter 2.5 - Carnitines (Including l-Carnitine, Acetyl-Carnitine, and Proprionyl-Carnitine). In: Nabavi SM, Silva AS, editors. Nonvitamin and Nonmineral Nutritional Supplements: Academic Press; 2019. p. 45-52.
Tarighat Esfanjani A, Mahdavi R, Ebrahimi Mameghani M, Talebi M, Nikniaz Z, Safaiyan A. The Effects of Magnesium, l-Carnitine, and Concurrent Magnesium–l-Carnitine Supplementation in Migraine Prophylaxis. Biological Trace Element Research. 2012;150(1- 3):42-8.
Kabbouche MA, Powers SW, Vockell ALB, LeCates SL, Hershey AD. Carnitine palmityltransferase II (CPT2) deficiency and migraine headache: Two case reports. Headache. 2003;43(5):490-5.
Abu-Arafeh I, Hershey AD, Diener H-C, Tassorelli C. Guidelines of the International Headache Society for controlled trials of preventive treatment of migraine in children and adolescents, 1st edition. Cephalalgia. 2019:033310241984218.
Headache Classification Committee of the International Headache Society (IHS) TheInternational Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
Hershey AD, Powers SW, Vockell ALB, LeCates S, Kabbouche MA, Maynard MK. PedMIDAS: Development of a questionnaire to assess disability of migraines in children. Neurology. 2001;57(11):2034-9.
Hershey AD. Current approaches to the diagnosis and management of paediatric migraine. The Lancet Neurology. 2010;9(2):190-204.
Sonal Sekhar M, Sasidharan S, Joseph S, Kumar A. Migraine management: How do the adult and paediatric migraines differ? Saudi Pharmaceutical Journal. 2012;20(1):1-7.
Nattagh-Eshtivani E, Sani MA, Dahri M, Ghalichi F, Ghavami A, Arjang P, et al. The role of nutrients in the pathogenesis and treatment of migraine headaches: Review. Biomedicine & Pharmacotherapy. 2018;102:317-25.
Hagen K, Brenner E, Linde M, Gravdahl GB, Tronvik EA, Engstrøm M, et al. Acetyll- carnitine versus placebo for migraine prophylaxis: A randomized, triple-blind, crossover study. Cephalalgia. 2015;35(11):987- 95.
Linde K, Rossnagel K. Propranolol for migraine prophylaxis. Cochrane Database Syst Rev. 2004(2):CD003225.
Srinivasan AV. Propranolol: A 50-year historicalAnnals of Indian Academy of Neurology. 2019;22(1):21.
Eidlitz-Markus T, Dlugatch Y, Haimi- Cohen Y, Goldberg-Stern H, Zeharia A. Nonpharmacologic Treatment of Migraine With Low-Dose Propranolol or Amitriptyline. Pediatric Neurology. 2012;46(6):345-9.
Togha M, Malamiri RA, Rashidi-Ranjbar N, Asa S, Mahvelati F, Ashrafi MR. Efficacy and safety of cinnarizine in the prophylaxis of migraine headaches in children: an open, randomized comparative trial with propranolol.
Acta Neurologica Belgica. 2012;112(1):51-5.
Ashrafi M, Shabanian R, Zamani G, Mahfelati F. Sodium valproate versus propranolol in paediatric migraine prophylaxis. European Journal of Paediatric Neurology. 2005;9(5):333-8.
VanderPluym J, Evans RW, Starling AJ. Long- Term Use and Safety of Migraine PreventiveMedications. Headache: The Journal of Headand Face Pain. 2016;56(8):1335-43.
Vécsei L, Majláth Z, Szok D, Csáti A, Tajti J. Drug safety and tolerability in prophylactic migraine treatment. Expert Opinion on Drug Safety. 2015;14(5):667-81.
Tajti J, Szok D, Csáti A, Vécsei L. Prophylactic Drug Treatment of Migraine in Children and Adolescents: An Update. Current Pain and Headache Reports. 2015;20(1).
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