From the Guidelines
Migraines in children should be managed with a combination of lifestyle modifications, trigger avoidance, and appropriate medications, with ibuprofen being the recommended first-line medication for acute treatment.
Key Considerations
- For acute treatment, ibuprofen is recommended as the first-line medication, given at the first sign of headache, as it has been shown to be effective in children and adolescents 1.
- For children with frequent or severe migraines, preventive treatments may include topiramate, amitriptyline, or propranolol, although their effectiveness in children and adolescents has not been proven in clinical trials 1.
- Lifestyle modifications are crucial and include maintaining regular sleep schedules, staying hydrated, eating regular meals, limiting screen time, and managing stress through relaxation techniques.
- Parents should help children identify and avoid personal triggers such as certain foods, bright lights, strong smells, or stress.
- Keeping a headache diary can help identify patterns and triggers.
Treatment Options
- Acetaminophen or ibuprofen can be used for acute treatment, with ibuprofen being the preferred option due to its anti-inflammatory properties 1.
- For adolescents aged 12–17 years, multiple NSAIDs and triptans have been approved for acute treatment of migraine, and some evidence indicates that nasal spray formulations of sumatriptan and zolmitriptan are the most effective 1.
- Preventive treatments such as topiramate, amitriptyline, or propranolol may be considered for children with frequent or severe migraines, although their effectiveness has not been proven in clinical trials 1.
Important Considerations
- Migraines in children often present differently than in adults, with shorter duration and bilateral (rather than unilateral) pain, and may include abdominal pain, nausea, or vomiting.
- Early intervention is important as recurring migraines can impact school attendance, social development, and overall quality of life.
- The evidence base for medication therapy in children and adolescents is confounded by a high placebo response in clinical trials, which may explain why a benefit of triptans has not been demonstrated in children 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.
Two controlled clinical trials evaluated sumatriptan nasal spray (5 to 20 mg) in 1,248 adolescent migraineurs aged 12 to 17 years who treated a single attack The trials did not establish the efficacy of sumatriptan nasal spray compared with placebo in the treatment of migraine in adolescents.
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
Sumatriptan is not recommended for use in pediatric patients, as the safety and effectiveness in this population have not been established. Clinical trials in adolescents aged 12 to 17 years did not establish the efficacy of sumatriptan in the treatment of migraine. Additionally, serious adverse reactions have been reported in the pediatric population after use of sumatriptan 2.
From the Research
Migraines in Kids
- Migraines can significantly reduce the quality of life in kids, contributing to significant school absences and disrupting social activities 3
- Common lifestyle factors such as stress, irregular mealtimes, and sleep deprivation may exacerbate migraines in adolescents 3
- The goal of managing episodic migraine in children and adolescents is to improve quality of life, including reducing missed school and other activities 4
Management Options
- Lifestyle modifications and migraine trigger avoidance are recommended as preventive measures for all individuals with migraine, including kids 5
- Current options for both abortive and preventative treatments in kids, as well as specific non-pharmacological and lifestyle management recommendations, are available 4
- Prescription medications, nutraceuticals, neurostimulation, and behavioral therapy are additional therapies that can be considered for preventive treatment 5
Treatment Options
- Ibuprofen, acetaminophen, and triptans are effective for the relief of migraine pain in children and adolescents, although confidence in the evidence varies between agents 6
- Oral sumatriptan/naproxen and zolmitriptan nasal spray are effective for adolescents, with high confidence that they are more likely to be headache free at 2 hours than those receiving placebo 6
- No acute treatments were effective for migraine-related nausea or vomiting, but some triptans were effective for migraine-related phonophobia and photophobia 6
Preventive Therapy
- The decision to recommend additional migraine preventive therapy should consider the frequency of migraine attacks and headaches, extent of migraine-associated disability, and patient preferences 5
- Treatments with the most favorable profiles include amitriptyline, beta-blockers, biofeedback, candesartan, coenzyme Q10, cognitive-behavioral therapy, magnesium citrate, onabotulinumtoxinA, relaxation therapy, riboflavin, and topiramate 5