Summary: For children or adolescents (aged 8 to 17 years) with a history of age with migraine occurring at least 4 days monthly, an approach of giving neither amitriptyline nor topiramate for headache prevention may be associated with the same degree of reduction in headache frequency, headache-related disability, and headache days as an approach of using either amitriptyline or topiramate for headache prevention, but with a lower likelihood of side effects such as fatigue, dry mouth, paresthesia, and weight loss. (In other words, amitriptyline and placebo appear to work no better for prophylaxis of pediatric migraine than placebo, but both medications are associated with higher rates of adverse events.)

Strength of Recommendation = B