From the Guidelines
Migraine treatment in kids should start with ibuprofen as the first-line medication, at a dose appropriate for body weight, due to its recommendation in the most recent and highest quality study. When considering treatment options, it's essential to take into account the unique characteristics of migraine in children and adolescents, such as shorter attack duration, bilateral headache, and prominent gastrointestinal disturbances 1.
- Key considerations in treating migraines in kids include:
- Education of family members and teachers to provide active help in clinical management
- Lifestyle modifications, such as maintaining regular sleep schedules and avoiding known triggers
- Use of domperidone for nausea in adolescents aged 12-17 years, although oral administration may not prevent vomiting
- For acute treatment, ibuprofen is the recommended first-line medication, and if ineffective, referral to specialist care is indicated 1.
- In adolescents aged 12-17 years, multiple NSAIDs and triptans have been approved for acute treatment, with nasal spray formulations of sumatriptan and zolmitriptan showing some evidence of effectiveness 1.
- Preventive treatments, such as propranolol, amitriptyline, and topiramate, are used in practice, although their effectiveness in children and adolescents has not been proven in clinical trials 1.
From the FDA Drug Label
Safety and effectiveness in pediatric patients have not been established. Sumatriptan tablets are not recommended for use in patients younger than 18 years of age. The frequency of all adverse reactions in these patients appeared to be both dose - and age-dependent, with younger patients reporting reactions more commonly than older adolescents Postmarketing experience documents that serious adverse reactions have occurred in the pediatric population after use of subcutaneous, oral, and/or intranasal sumatriptan.
Migraine treatment in kids is not established with sumatriptan. The drug is not recommended for use in patients younger than 18 years of age due to lack of safety and efficacy data.
- Adverse reactions in pediatric patients are dose- and age-dependent.
- Serious adverse reactions have been reported in the pediatric population after use of sumatriptan 2.
From the Research
Migraine Treatment in Kids
- Migraine treatment in children and adolescents can be approached through a three-pronged treatment plan, including lifestyle management counseling, optimally dosed acute therapy, and preventive treatment 3.
- Lifestyle modifications, such as regular sleep, exercise, hydration, and avoidance of meal skipping, can help prevent migraine attacks in kids 3, 4, 5.
- Acute migraine treatment in adolescents can include triptans, with four triptans labeled by the US Food and Drug Administration (FDA) for use in adolescents, and rizatriptan labeled for use in children age 6 and older 3.
- Preventive migraine treatment in children and adolescents can include medications such as beta-blockers, flunarizine, topiramate, valproate, and amitriptyline, with the choice of medication depending on efficacy, co-morbidity, side effects, availability, and cost 6.
- Non-pharmacological treatments, such as relaxation techniques, bio-feedback, cognitive behavioral therapy, and acupuncture, can also be used to prevent migraine attacks in kids, although they require more specialist time or technical devices 6.
- Identification and avoidance of triggers, such as obesity, overweight, particular foods, and dysfunctional family situations, can also help prevent migraine attacks in children 4.
- Educational programs that advise pediatric patients to follow a correct lifestyle can improve quality of life and assist adult patients in avoiding headache chronicity, increasing general well-being 5.