Childhood and Adolescent Migraine Prevention [CHAMP] Trial: The 3-year Follow-up Survey Results

Scott W. Powers, PhD, ABPP, FAHS

AHSAM 2020 - Oral session
Published on July 30, 2020

2 minute listen

7 minute read

Key messages

  • Clinical improvements reported from the CHAMP study were maintained at three-year follow up.
  • There were no differences in headache frequency and disability between individuals taking amitriptyline or topiramate.
  • Migraine preventative medication can be stopped in youths with continued good functioning.
  • Background

    What do we already know about this topic?
  • Findings

    What does this study add?
  • Perspectives

    How does this study impact clinical practice?
  • Expert commentary

    by Marcy Yonker, MD, FAHS

Key messages

  • Clinical improvements reported from the CHAMP study were maintained at three-year follow up.
  • There were no differences in headache frequency and disability between individuals taking amitriptyline or topiramate.
  • Migraine preventative medication can be stopped in youths with continued good functioning.

Background

What do we already know about this topic?

  • The CHAMP 24-week study was a Phase 3 randomized, double-blind, clinical trial evaluating amitriptyline (1 mg/kg QD) and topiramate (2 mg/kg QD) verus placebo across individuals with migraine, aged 8 to 17 years old (n=361).
  • The primary outcome was a relative reduction of 50% or more in the number of headache days, and secondary outcomes were headache-related disability, headache days, number of trial completers, and serious adverse events that emerged during treatment.
  • At 24-weeks, neither medication was superior to placebo in the reduction of headache days nor disability, and there were greater side effects with both medications.1
  • Most youths showed a notable reduction in headache frequency, even if they didn’t meet the 50% reduction endpoint.
  • The follow-up survey examined headache days and disability at 3, 6, 12, 18, 24, and 36 months post-CHAMP.

How was this study conducted?

  • Internet-based survey reporting headache days, PedMIDAS disability assessment and use of prescription migraine prevention medication.
  • Surveyed youths diagnosed with migraine (n=205) from the original CHAMP study, blind to the treatment previously received, at 3-months, then 6-month intervals across 3-years.
  • Since the CHAMP study, subjects had freely chosen their own type of medical care.

Findings

What does this study add?

  • The improvement in headache days and disability from the CHAMP study were at maintained 3-years.
  • No differences were reported in headache frequency and disability between individuals taking amitriptyline or topiramate.
  • Up to 88% of individuals did not take prevention medicine after the CHAMP study.

Perspectives

How does this study impact clinical practice?

  • The use of preventative medications in patients can be stopped with realistic and informed expectations for continued good functioning.
  • The data informs use and stopping of newer therapies in pediatric/youth patient populations.
  • Adds to the ongoing active debate about use of preventative medications in youth, as although the FDA approved topiramate for the treatment of episodic migraine in adolescents 12 to 17 years of age during the CHAMP trial, it did not perform better in the trial, which had a high placebo rate.1
  • This provides the long-term follow-up data necessary for 2019 practice guidelines.2

Perspectives

How does this study impact clinical practice?

  • The use of preventative medications in patients can be stopped with realistic and informed expectations for continued good functioning.
  • The data informs use and stopping of newer therapies in pediatric/youth patient populations.
  • Adds to the ongoing active debate about use of preventative medications in youth, as although the FDA approved topiramate for the treatment of episodic migraine in adolescents 12 to 17 years of age during the CHAMP trial, it did not perform better in the trial, which had a high placebo rate.1
  • This provides the long-term follow-up data necessary for 2019 practice guidelines.2

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Scott W. Powers, PhD, ABPP, FAHS
Professor of Pediatrics and CCRF Endowed Chair
Cincinnati Children's Hospital and University of Cincinnati College of Medicine
Wyoming, Ohio

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.

In addition, an expert commentary on the topic has been provided by:

Marcy Yonker, MD, FAHS
Professor of Clinical Practice, University of Colorado School of Medicine
Director, Pediatric Headache Program, Children's Hospital Colorado

Marcy Yonker, MD, FAHS
Professor of Clinical Practice, University of Colorado School of Medicine
Director, Pediatric Headache Program, Children's Hospital Colorado

Dr. Marcy Yonker is a board certified Pediatric Headache Specialist who has spent the past 20 years in Philadelphia, Phoenix and now Denver treating children with severe headache problems, training headache fellows and participating in clinical research with her many headache friends across the country. She holds the Francescon Endowed Chair in Headache and is a full professor in Clinical Practiceat the University of Colorado School of Medicine and directs the Pediatric Headache Program at Children's Colorado.

1. Powers et al. Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine. The New England Journal of Medicine 2017;376:115-124.

2. Oskoui M, Pringsheim T, Billinghurst L et al. Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention. Neurology 2019;93:500-509.



Headache
Pediatrics


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