From the Guidelines
Migraines in children can be effectively managed with a combination of lifestyle adjustments and appropriate medications, with ibuprofen being the recommended first-line medication for acute treatment, as stated in the 2021 study published in Nature Reviews Neurology 1. When managing migraines in children, it is essential to consider the differences in clinical features compared to adults, such as shorter attack duration, bilateral headache, and prominent gastrointestinal disturbances.
- The diagnosis of migraine in children is primarily based on medical history, with criteria slightly different from those for adults, including a duration of 2 to 72 hours 1.
- Clinical management often requires active help from family members and teachers, making education of both necessary, as highlighted in the 2021 study 1.
- For acute treatment, ibuprofen is recommended as the first-line medication, at a dose appropriate for body weight, as stated in the 2021 study published in Nature Reviews Neurology 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, as mentioned in the 2021 study 1 and further supported by the 2020 study published in JAMA Neurology 2.
- For prevention in frequent migraines, medications such as propranolol, amitriptyline, and topiramate may be considered, although their effectiveness in children and adolescents has not been proven in clinical trials, as noted in the 2021 study 1 and the 2020 study 2.
- Lifestyle modifications, including maintaining regular sleep schedules, staying hydrated, eating regular meals, limiting screen time, and identifying personal triggers, are crucial in managing migraines in children, as emphasized in the 2020 study 2.
From the Research
Treatment Options for Kids with Migraine
- There is evidence to support the efficacy of the use of ibuprofen, acetaminophen, and triptans for the relief of migraine pain in children and adolescents, although confidence in the evidence varies between agents 3.
- Acetaminophen is suitable for mild to moderate migraine attacks and remains the first choice for children 4, 5.
- Triptans, such as sumatriptan and zolmitriptan, are effective for migraine-related phonophobia and photophobia, but not for nausea or vomiting 3.
- 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.
Acute Treatment Strategies
- The acetaminophen-NSAID strategy is suitable for patients with attacks of mild to moderate severity 5.
- The triptan strategy is suitable for patients with severe attacks and for those with attacks of moderate severity who do not respond well to NSAIDs 5.
- Antiemetics can be used as supplement to alleviate nausea and vomiting, but are not effective for acute migraine treatment 4, 5.
- Opiates are not recommended for acute migraine treatment due to serious adverse events 4, 5, 6.
Prevention and Lifestyle Factors
- Counseling on lifestyle factors that can exacerbate migraine, including trigger avoidance and medication overuse, is important for the treatment of acute migraine in children and adolescents 3.
- Antidepressants, such as amitriptyline and nortriptyline, can be used as preventive treatment for migraine, but further research is needed to determine their efficacy and tolerability 7.