What medication can be provided for a 10-year-old with migraine?

Medication Options for a 10-Year-Old with Migraine

For a 10-year-old child with migraine, ibuprofen (7.5-10 mg/kg) or acetaminophen (15 mg/kg) should be used as first-line treatment for acute attacks. 1, 2

Acute Treatment Options

First-Line Medications

• Ibuprofen: 7.5-10 mg/kg per dose

  • Most effective NSAID with strong evidence for pediatric migraine 3, 2
  • Few adverse effects in children when used appropriately
  • Can be given at onset of headache

• Acetaminophen: 15 mg/kg per dose

  • Effective alternative when NSAIDs are contraindicated 1
  • Generally well-tolerated in children
  • Can be given at onset of headache

Second-Line Options

• Sumatriptan nasal spray (for severe attacks that don't respond to first-line treatments)
  • Note: While oral sumatriptan has not shown efficacy in pediatric trials, nasal spray formulation has demonstrated effectiveness in adolescents 4
  • Should be reserved for children who don't respond to NSAIDs or acetaminophen
  • Not FDA-approved for children under 12 years

Treatment Approach

1. Start treatment as early as possible after migraine onset for better efficacy 1
2. Begin with ibuprofen or acetaminophen for mild to moderate attacks
3. Ensure adequate hydration and rest during attacks
4. Consider a quiet, dark environment during attacks to minimize sensory stimulation

Preventive Treatment

If the child experiences ≥4 headache days per month or significant disability despite acute treatment, consider preventive therapy:

• Topiramate: May be considered for children 10 years and older 5, 6

  • Starting dose: Begin at 25 mg nightly for the first week
  • Titration: Increase by 25 mg weekly as tolerated
  • Target dose: Based on weight, approximately 5-9 mg/kg/day in two divided doses
  • Caution: Monitor for side effects including cognitive slowing, weight loss, and paresthesias

• Flunarizine: 5 mg/day has shown efficacy in multiple controlled trials 3, 2

  • Not available in the United States
  • Most evidence-supported preventive option in pediatric migraine

• Propranolol: Consider for prevention at >60 mg/day 3, 6

  • Mixed evidence in pediatric populations
  • Monitor for fatigue, dizziness, and hypotension

Non-Pharmacological Approaches

These should be implemented alongside medication:

• Maintain regular sleep schedule
• Stay well hydrated
• Identify and avoid personal triggers using a headache diary
• Regular aerobic exercise appropriate for age
• Stress management techniques 1

Important Considerations

• Avoid medication overuse: Limit acute medications to ≤10 days/month for triptans and ≤15 days/month for NSAIDs 1
• Avoid opioids and butalbital due to risk of medication overuse headache and other adverse effects 1
• Evaluate response to preventive medications after 6-8 weeks; if inadequate, consider switching to another agent 1
• Consider comorbidities when selecting medications

Common Pitfalls to Avoid

• Delaying treatment of acute attacks (early intervention is more effective)
• Using adult dosing in children
• Overlooking lifestyle factors that may trigger migraines
• Failing to educate the child and family about migraine management
• Not considering preventive therapy when attacks are frequent or disabling

Remember that management should focus on reducing attack frequency, severity, and associated disability while minimizing medication side effects.