Abortive Medications for Headaches in an 11-Year-Old
Ibuprofen is the first-line abortive medication for an 11-year-old with headaches, with acetaminophen as an equally appropriate alternative, both demonstrating approximately 60-65% improvement rates within two hours in pediatric migraine patients. 1
First-Line Treatment Options
For mild to moderate headache attacks:
- Ibuprofen 10 mg/kg (maximum 400-800 mg per dose) is the most commonly used and effective abortive treatment in children. 1 The medication should be administered as early as possible during the attack to maximize efficacy. 2
- Acetaminophen 15 mg/kg (maximum 1000 mg per dose) is equally appropriate and may be particularly effective in male children, showing a 95% improvement rate in some pediatric studies. 1
- Both medications can be given every 4-6 hours as needed, but total use must be strictly limited to no more than 2 days per week to prevent medication-overuse headache. 2, 3
Critical Frequency Limitation
The most important pitfall to avoid is allowing the child to use abortive medications more than twice weekly. 2, 3 Medication-overuse headache results from frequent use of acute medications and leads to increasing headache frequency, often progressing to daily headaches. 2 If the child requires abortive treatment more than twice per week, preventive therapy should be initiated immediately rather than increasing the frequency of acute medications. 2, 4
When to Add Antiemetic Therapy
If nausea or vomiting accompanies the headaches, adding an antiemetic 20-30 minutes before the analgesic can provide synergistic pain relief beyond just treating the nausea. 3 Metoclopramide has direct analgesic effects through central dopamine receptor antagonism and is not restricted only to patients who are vomiting. 3
Escalation Strategy for Treatment Failure
If ibuprofen or acetaminophen fail after 2-3 headache episodes, the child should be evaluated for:
- Medication-overuse headache if using abortive medications too frequently 2, 5
- Need for preventive therapy if attacks occur more than twice monthly and produce disability lasting 3 or more days 2, 4
- Consideration of migraine-specific therapy in adolescents, though triptans are generally reserved for older adolescents and have limited pediatric data 2, 6
Medications to Avoid in Pediatric Patients
Opioids and butalbital-containing compounds should be avoided in children as they lead to dependency, rebound headaches, and eventual loss of efficacy. 2, 3 These should only be reserved for extreme situations when other medications cannot be used and the risk for abuse has been addressed. 2
Practical Implementation
Most children use a single medication for each headache episode, which is the appropriate approach. 1 The medication should be taken at the first sign of headache while pain is still mild, as early administration significantly improves efficacy. 2 Parents should maintain a headache diary to track frequency, severity, and medication response to guide treatment decisions. 4