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Original Research

Program: Section on Hospital Medicine

P4A089: A Comparison Between Amitriptyline and Riboflavin (vitamin B2) for Being Used in Childhood Abdominal Migraine Prophylaxis

Monday, October 23, 2023
10:00 AM – 12:00 PM US EDT
Location: Walter E. Washington Convention Center, Exhibit Hall A
Poster Presentation
Background: Riboflavin (vitamin B2), as well as Amitriptyline, are used as prophylactic medications for childhood migraine headaches. This study has been done to compare both drug effects on childhood abdominal Migraine (AM) prophylaxis.

Methods: This study was conducted with over 56 participants from June 2021 to March 2022.
Ages range from 8 to 14 years. They were randomly assigned in a 1:1 ratio into 2 groups Amitriptyline group (n=28) and Riboflavin (vitamin B2) group (n=28). Both groups have no other medical background and were explained the possible side effects of both drugs. The diagnosis of abdominal migraine was based on Rome IV Diagnostic Criteria for Child Abdominal Migraine. A good response to treatment was defined as more than a 50% decrease in the monthly abdominal ache frequency during follow-up. The Amitriptyline group received it in a dose of 1 mg/kg daily for 6 months. The Riboflavin group received it in a dose of 200 mg for the same period. The primary outcomes were a monthly frequency of abdominal pain attacks, a good response to intervention, and a reduction in migraine severity, duration, and disability before and after treatment.

Results: A good response was observed in 75% of patients (21 children) in the Amitriptyline group and 53.5% of patients (15 children) in the Riboflavin group. Amitriptyline was significantly more effective than Riboflavin (P =.01). Side effects were observed in 14.28% (4 children) in the Amitriptyline group mainly mild constipation & sedation. The Riboflavin group has almost no side effects except in 7.14% (2 children) who felt urine is more yellow than normal. Comparisons of abdominal migraine characteristics before and after intervention in both groups showed that Amitriptyline was more effective than Riboflavin in the reduction of monthly frequency, severity, duration, and disability for abdominal migraines.

Conclusion: Accordingly, Amitriptyline may be used with caution for childhood Abdominal Migraine (AM) prophylaxis, by daily administration of 1mg/kg with a good outcome rather than Riboflavin.
Further randomized controlled trials with a larger sample size and a longer duration of follow-up are recommended.