# 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.

## Key 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.