We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

No Evidence of Efficacy or Evidence of No Efficacy

Marco A. Arruda, MD, PhD
JAMA Pediatr. 2013;167(3):300-302. doi:10.1001/jamapediatrics.2013.1105.
Text Size: A A A
Published online


Headache is an almost universal complaint. In any given month, nearly 49% of children will report headaches, with 4.2% of those having headaches on 10 or more days per month.1 Affecting nearly 8% of children and adolescents, migraine is the most important cause of pediatric consultations due to headaches.2

The clinical presentation of migraine varies as a function of age,3 and this has diagnostic and therapeutic importance.4 Indeed, the diagnosis and treatment of migraine in children and adolescents resembles a kaleidoscope with many facets of striking peculiarities—in young children, the attacks may be very short and sometimes headaches are not present, such as in the associated periodic syndromes (eg, cyclical vomiting and abdominal migraine). More frequently than adults, children seem to respond to treatment with simple analgesics, and this may probably reflect their exacerbated placebo response. When measured in the context of clinical trials, nearly 55% of children receiving placebo prophylaxis achieve the primary end point and the rate approaches 70% with acute therapy. In adults, rates are close to 35% and 45%, respectively.5 Factors that explain the high placebo rate in children include regression to the mean (short duration of attacks), inadequate study designs, and beliefs and perceptions that are inherent to the age group.6

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

13 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Who Should Be Assessed for Migraine?