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Nebulised normal saline in bronchiolitis

Many drugs have been used to treat migraine. However, a systematic review and network meta-analysis found only 23 randomised controlled trials involving 2217 children. The primary outcomes were efficacy (days or frequency of migraine headaches, safety (adverse events leading to treatment discontinuation) and acceptability (treatment discontinuation for any reason). Prophylactic treatments examined included anti-epileptics, anti-depressants, calcium channel blockers, anti-hypertensive agents and food supplements. Propranolol (standard mean difference = 0.60; 95% confidence interval (CI) 0.03–1.17) and topiramate (standard mean difference = 0.59; 95% CI 0.03–1.15) were significantly more effective than placebo, but only short term (<5 months). No prophylactic intervention was found to have statistically significant long-term benefit compared to placebo. In randomised controlled trials of migraine treatment in children, there is a significant placebo effect. In the CHAMP study, 61% of placebo recipients achieved the primary outcome, a reduction of 50% in the number of headache-days in the last 28 days compared with the first 28 days of a 24-week trial. Anecdotal response to chemoprophylaxis, therefore, is not trustworthy. Current evidence suggests drugs may be no more effective than acupuncture or even than the ancient Egyptian therapy of bandaging a clay crocodile to the head (Fig. 1). We should not be prescribing drugs for long-term chemoprophylaxis of childhood migraine.