Clinical predictors of propranolol responsiveness in pediatric migraine: a prospective observational study

TL;DR

This study found that propranolol and behavioral therapy both reduce migraine severity in children, with vitamin deficiencies and certain conditions predicting treatment response.

Contribution

The study identifies clinical and biochemical predictors of propranolol responsiveness in pediatric migraine patients.

Findings

Both propranolol and behavioral therapy significantly reduced migraine frequency and disability in children.

Vitamin D and B12 deficiencies were linked to poorer treatment outcomes in propranolol-treated patients.

Benign paroxysmal vertigo and essential tremor predicted better propranolol response in children with migraines.

Abstract

Background: This study aimed to evaluate the comparative effectiveness
of propranolol therapy and structured behavioral interventions in reducing
headache severity in pediatric patients and to identify predictors of treatment
response. Methods: In this prospective, single-center study, 178
pediatric patients diagnosed with migraine based on the International
Classification of Headache Disorders, 3rd edition (ICHD-3) criteria were
enrolled. Participants were allocated into two groups according to baseline
Pediatric Migraine Disability Assessment Scale (PedMIDAS) scores: Group 1
(PedMIDAS <15, n = 88) received standardized behavioral therapy, while Group 2
(PedMIDAS ≥15, n = 90) received propranolol (1–3 mg/kg/day) for 12 weeks.
Primary outcomes were predefined as changes in monthly migraine attack frequency,
PedMIDAS scores, and Visual Analog Scale (VAS)-measured headache intensity.
Vitamin D deficiency and vitamin B12 deficiency were evaluated as
biochemical predictors, and adherence was monitored bi-weekly. Results:
Both groups showed significant improvement at week 12. Monthly migraine attacks
declined from 3.5 ± 1.6 to 2.1 ± 1.2 in Group 1 and from 6.4 ±
2.1 to 3.1 ± 1.7 in Group 2. PedMIDAS scores decreased from 8.60 ±
3.25 to 5.75 ± 2.52 and 24.40 ± 9.65 to 16.11 ± 7.72,
respectively (p < 0.001 both). VAS scores also improved in both groups
with no significant between-group difference in percentage reduction. A
≥50% reduction in attack frequency plus ≥1-grade PedMIDAS
improvement defined treatment response. In the propranolol group, response was
independently associated with benign paroxysmal vertigo and essential tremor,
while vitamin D and vitamin B12 deficiency predicted poorer outcomes.
Conclusions: Both propranolol and structured behavioral therapy
effectively reduce migraine-related disability and pain in pediatric patients,
yielding comparable proportional improvements. The identification of key clinical
and biochemical predictors supports a personalized treatment approach,
integrating comorbidity screening and nutritional assessment to optimize
outcomes. Clinical Trial Registration: ClinicalTrials.gov/NCT07180043,
retrospectively registered.

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