Powers SW, et al. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. PMID 27788026

Question and design

CHAMP randomized 361 participants aged 8–17 years to amitriptyline, topiramate or placebo for migraine prevention. The trial stopped early for futility.

Primary result

Arm	≥50% reduction in headache days
Amitriptyline	52%
Topiramate	55%
Placebo	61%

Neither active drug was superior to placebo, and active treatment produced more adverse events.

Interpretation

CHAMP is a warning against importing adult preventive efficacy into children by pharmacological analogy. It also demonstrates that trial participation, expectation, monitoring and natural fluctuation can generate large improvement without active drug.

What it does not show

• It does not prove that no individual child benefits from either medicine.
• It does not invalidate behavioural treatment; a separate trial found incremental benefit from CBT when both arms received amitriptyline (PMID 24368463).
• It does not resolve treatment for highly refractory or phenotypically distinct subgroups excluded from the trial.

Knowledge-base use

Anchors the pediatric page and the broader rule that placebo response and age-specific evidence must shape inference.