From the Guidelines
For headache treatment, start with over-the-counter pain relievers like ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours, as it is effective for treating migraine headaches in children and adolescents, as recommended by the 2020 JAMA Neurology study 1.
Key Recommendations
- Take a detailed history and make a specific headache diagnosis to guide treatment decisions 1.
- Advise patients on lifestyle factors, migraine triggers, and avoidance of acute medication overuse to prevent frequent or disabling headaches 1.
- Counsel patients to treat acute migraine early in the attack for better pain management 1.
Treatment Options
- Use ibuprofen to treat pain in children and adolescents, and consider sumatriptan/naproxen oral, zolmitriptan nasal, sumatriptan nasal, rizatriptan ODT, or almotriptan oral in adolescents 1.
- If one triptan is ineffective, try another or a non-steroidal anti-inflammatory drug-triptan combination, and consider non-oral triptans for quick pain relief or adding anti-emetics for nausea and vomiting 1.
Preventive Treatments
- Consider preventive treatments in children and adolescents with frequent or disabling headaches or medication overuse, and discuss the evidence for and side effects of preventive medications with patients and families 1.
From the FDA Drug Label
Before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with atypical symptoms, exclude other potentially serious neurological conditions. Medication overuse headache may present as migraine-like daily headaches or as a marked increase in frequency of migraine attacks Detoxification of patients, including withdrawal of the overused drugs, and treatment of withdrawal symptoms (which often includes a transient worsening of headache) may be necessary.
The treatment options for headache (cephalgia) include:
- Excluding other potentially serious neurological conditions before treating headaches in patients not previously diagnosed as migraineurs, and in migraineurs who present with atypical symptoms.
- Detoxification of patients, including withdrawal of the overused drugs, and treatment of withdrawal symptoms for medication overuse headache.
- Triptans, such as sumatriptan 2, rizatriptan 3, and zolmitriptan 4, may be used to treat migraine headaches, but with caution and consideration of the patient's cardiovascular risk factors and medical history.
From the Research
Treatment Options for Headache (Cephalgia)
- The primary goals of acute migraine therapy are to reduce attack duration and severity 5
- Current evidence-based therapies for acute migraine attacks include: + Acetaminophen + Nonsteroidal anti-inflammatory drugs (NSAIDs) + Triptans + NSAID-triptan combinations + Dihydroergotamine + Non-opioid combination analgesics + Anti-emetics 6, 5
- Over-the-counter medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, are considered first-line therapy for mild-to-moderate migraine attacks 5
- Sumatriptan, a triptan, is available in different formulations, including subcutaneous, intranasal, transdermal, oral, and suppository options, and is used as both first-line and rescue therapies 7
- Paracetamol (acetaminophen) with or without an antiemetic is also effective in the treatment of acute migraine headaches in adults 8
- The choice of treatment depends on the severity of the migraine, the patient's medical history, and the presence of any contraindications or allergies 6, 9, 5, 7, 8
First-Line Treatments
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatments for mild to moderate migraines 6
- Triptans, such as sumatriptan, are first-line treatments for moderate to severe migraines 6, 9, 7
- Over-the-counter medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, are considered first-line therapy for mild-to-moderate migraine attacks 5