The problem of a migraine is considered among the ten most disabling disorders that may arise in any age group. Various medications are available for the prevention and treatment of a migraine in pediatric patients. This study enlightens the efficacy of an approved anticonvulsant drug topiramate among adolescents generating mixed results.

Based on the success of treatment, various medications are prescribed to prevent pediatric migraines. Topiramate, the drug approved for migraine prevention in children as young as 12 years of age. This meta-analysis was aimed to assess the published data supporting the efficacy of topiramate for the prevention of a migraine in patients less than 18 years of age.

Various online journals PubMed/Medline, Embase and the Cochrane Library (from inception to April 2017) were searched for randomized controlled trials (RCTs) published in English. Data was extracted by two independant investigators  and quality was evaluated by using the Cochrane Collaboration’s tool. The extracted data was then analyzed by the Review Manager 5.3 software.

A total of four Randomised Clinical Trials with matched inclusion criteria were included in this review. With an aggregate of 465 patients, only 329 were included in the topiramate group, and 136 were included in the placebo group. The meta-analysis revealed that in comparison with placebo, topiramate failed to decrease the number of patients experiencing a ≥ 50% relative reduction in headache frequency (n = 465, RR = 1.26, 95% CI = [0.94,1.67], Z = 1.55, P = 0.12) or the number of headache days (n = 465, MD = −0.77, 95% CI = [−2.31,0.76], Z = 0.99, P = 0.32) but did reduce PedMIDAS scores (n = 205, MD = −9.02, 95% CI = [−17.34, −0.70], Z = 2.13, P = 0.03). A higher rates of side effects and adverse events were observed in the topiramate group than in the placebo group.

Topiramate may not be an effective in the prevention of migraines in patients less than 18 years of age, and topiramate may lead to more side effects or adverse events in the included patients.