From the Guidelines
The best treatment for pediatric migraines involves a combination of lifestyle modifications and medications, with ibuprofen being the recommended first-line treatment for acute migraine attacks in children and adolescents. According to the 2020 study published in JAMA Neurology 1, taking a detailed history and making a specific headache diagnosis is crucial. Additionally, advising patients and families on lifestyle factors, migraine triggers, and avoidance of acute medication overuse is recommended. For acute treatment, the study suggests using ibuprofen to treat pain in children and adolescents, while in adolescents, sumatriptan/naproxen oral, zolmitriptan nasal, sumatriptan nasal, rizatriptan ODT, or almotriptan oral may be considered 1. Some key points to consider when treating pediatric migraines include:
- Counseling patients to treat acute migraine early in the attack 1
- Trying another triptan or a non-steroidal anti-inflammatory drug-triptan combination if one triptan is ineffective 1
- Using non-oral triptans if headache pain spikes quickly or if nausea/vomiting occurs, and adding anti-emetics if necessary 1
- Considering preventive treatments in children and adolescents with frequent or disabling headaches or medication overuse 1 Preventive treatments, such as amitriptyline combined with cognitive behavioral therapy, topiramate, and propranolol, may be discussed with patients and families, taking into account the evidence for and side effects of these medications 1.
From the Research
Treatment Options for Pediatric Migraines
The treatment of pediatric migraines can be approached through various methods, including:
- Acute pharmacological interventions, such as NSAIDs and triptans, which have been shown to be effective in managing migraine attacks 2, 3, 4
- Education of patients regarding self-management techniques, which can help improve outcomes 2
- Psychological interventions, such as biofeedback, relaxation, and cognitive-behavioral therapy, which can be beneficial in managing migraine symptoms 2, 5
Pharmacological Interventions
Pharmacological interventions for pediatric migraines include:
- Acetaminophen and ibuprofen, which are often effective in managing migraine attacks 3, 4
- Triptans, which can be a useful therapeutic option in adolescents 3, 4
- Preventive medications, such as flunarizine and topiramate, which may be effective in reducing migraine frequency 3, 5
Non-Pharmacological Interventions
Non-pharmacological interventions for pediatric migraines include:
- Lifestyle modifications, such as avoiding triggers and maintaining a healthy lifestyle 6, 5
- Behavioral strategies, such as cognitive-behavioral therapy and relaxation techniques 2, 6, 5
- Biofeedback and other psychological interventions, which can help manage migraine symptoms 2, 5
Future Directions
More research is needed to determine the most effective treatment approaches for pediatric migraines, including the role of pharmacological and nutraceutical interventions, and the mechanisms of the clinically relevant placebo response 2, 3, 4