From the Guidelines
For treating migraines in a 12-year-old, I strongly recommend starting with ibuprofen to treat pain, as advised by the recent guidelines 1.
Treatment Approach
When managing migraines in a 12-year-old, it's crucial to take a detailed history and make a specific headache diagnosis, as well as advise patients and families on lifestyle factors, migraine triggers, and avoidance of acute medication overuse 1.
- Counsel the patient to treat acute migraine early in the attack, and consider sumatriptan/naproxen oral, zolmitriptan nasal, sumatriptan nasal, rizatriptan ODT, or almotriptan oral for 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 spikes or nausea/vomiting 1.
Preventive Treatments
Consider preventive treatments in children/adolescents with frequent or disabling headaches or medication overuse, and discuss the evidence for and side effects of amitriptan, topiramate, and propranolol for migraine prevention 1.
- The use of preventive medication should be discussed with patients/families, considering that placebo was as effective as the studied medication in many trials 1.
Lifestyle Modifications
Ensure the child maintains regular sleep patterns, stays hydrated, and practices stress management techniques like deep breathing or meditation to help manage migraines.
- Keep a headache diary to track triggers, symptoms, and medication effectiveness, and consider non-pharmacological approaches like cognitive behavioral therapy and biofeedback 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. Five controlled clinical trials (2 single-attack trials, 3 multiple-attack trials) evaluating oral sumatriptan (25 to 100 mg) in pediatric patients aged 12 to 17 years enrolled a total of 701 adolescent migraineurs. These trials did not establish the efficacy of oral sumatriptan compared with placebo in the treatment of migraine in adolescents
Treatment for migraines in a 12-year-old is not established. The safety and effectiveness of sumatriptan in pediatric patients have not been established, and it is not recommended for use in patients younger than 18 years of age 2.
From the Research
Treatment Options for Migraines in a 12-Year-Old
- The American Academy of Neurology and the American Headache Society recommend the use of ibuprofen, acetaminophen, and triptans (mainly in adolescents) for the relief of migraine pain in children and adolescents 3.
- Acetaminophen is suitable for mild to moderate migraine attacks and remains the first choice for children 4, 5.
- Triptans, such as sumatriptan, are available in different formulations, including oral, intranasal, and subcutaneous options, and can be used as first-line or rescue therapies 6.
- The combination of a triptan and a non-steroidal anti-inflammatory drug (NSAID) has demonstrated better efficacy in treating migraine attacks 7.
Administration and Dosage
- The administration of acute medications should follow the concept of "stratified care", with oral NSAIDs as the first choice for mild to moderate migraine attacks, and oral or nasal spray triptans for moderate to severe attacks 4.
- The use of acute treatment should be limited to a maximum of ten days a month to prevent medication-overuse headache 4.
Considerations for Children and Adolescents
- The treatment of acute migraine in children and adolescents should focus on the importance of early treatment, choosing the route of administration best suited to the characteristics of the individual migraine attack, and providing counseling on lifestyle factors that can exacerbate migraine 3.
- Patient-specific clinical features should help guide the selection of an acute medication for an individual patient, taking into account the severity of the attack, the presence of nausea or vomiting, and any contraindications to certain medications 5.