Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine

Multicenter RCT, n=361, ages 8-17, episodic migraine. Amitriptyline and topiramate did NOT outperform placebo (~50% response across all arms), with more adverse events in active drugs. Trial stopped early for futility. Reframed practice: first-line should be non-pharmacological (CBT, biofeedback, lifestyle), pharmacology reserved for severe cases.