From the Guidelines
Migraine headaches in children and adolescents should be treated with ibuprofen as the first-line option, and if ineffective, consider sumatriptan or other triptans, with preventive treatments discussed for frequent or disabling headaches. When treating migraine headaches, it is essential to take a detailed history and make a specific headache diagnosis 1. The treatment approach should include advising patients and families on lifestyle factors, migraine triggers, and avoidance of acute medication overuse 1. For acute treatment, the following options are recommended:
- Ibuprofen for children and adolescents
- 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 1
- If headache pain spikes quickly, try a non-oral triptan, and if nausea/vomiting occurs, try a non-oral triptan or add an anti-emetic 1 Preventive treatments should be considered in children and adolescents with frequent or disabling headaches or medication overuse, with options including amitriptyline combined with cognitive behavioral therapy, topiramate, and propranolol 1. It is crucial to discuss the evidence for and side effects of these medications with patients and families, including the potential teratogenic effects of topiramate and valproate 1. By taking a comprehensive approach to treating migraine headaches, healthcare providers can help improve the quality of life for children and adolescents suffering from this condition.
From the FDA Drug Label
The estimated probability of achieving an initial headache response within 2 hours following treatment in pooled Studies 1,2,3, and 4 is depicted in Figure 1 The averages displayed are based on pooled data from 4 placebo-controlled, outpatient trials providing evidence of efficacy (Studies 1,2,3, and 4). For patients with migraine-associated photophobia, phonophobia, and nausea at baseline, there was a decreased incidence of these symptoms following administration of rizatriptan benzoate compared to placebo The percentage of patients achieving the primary efficacy endpoint of no headache pain at 2 hours after treatment was significantly greater in patients who received rizatriptan benzoate orally disintegrating tablets, compared with those who received placebo (33% vs. 24%)
Migraine Headache Treatment with Rizatriptan:
- Rizatriptan is effective in treating migraine headaches, with a significant percentage of patients achieving no headache pain at 2 hours after treatment.
- The drug also reduces the incidence of migraine-associated symptoms such as photophobia, phonophobia, and nausea.
- The efficacy of rizatriptan is unaffected by the presence of aura, gender, age, or concomitant use of common migraine prophylactic drugs.
- Rizatriptan is also effective in pediatric patients 6 to 17 years of age, with a significant percentage of patients achieving no headache pain at 2 hours after treatment 2.
- Sumatriptan, another drug for migraine treatment, has a similar mechanism of action, binding to 5-HT1B/1D receptors and causing cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release 3.
From the Research
Migraine Headache Treatment Options
- Migraine headaches are a neurologic disorder characterized by attacks of moderate to severe throbbing headache, typically unilateral, exacerbated by physical activity, and associated with phonophobia, photophobia, nausea, and vomiting 4.
- The primary goals of acute migraine therapy are to reduce attack duration and severity, with current evidence-based therapies including acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, NSAID-triptan combinations, dihydroergotamine, non-opioid combination analgesics, and several anti-emetics 4, 5.
Over-the-Counter Medications
- Over-the-counter medications, such as acetaminophen, ibuprofen, naproxen, and aspirin, are an important component of migraine therapy and are considered a first-line therapy for most migraineurs 4.
- These medications have shown strong efficacy when used as first-line treatments for mild-to-moderate migraine attacks, with the added benefits of lower cost and fewer adverse effects compared to prescription medications 4, 5.
Triptans and Combination Therapies
- Triptans, such as sumatriptan, are the first-line treatment for moderate-to-severe migraine headaches, with different formulations available, including subcutaneous, intranasal, transdermal, oral, and suppository options 6, 7.
- Combination therapies, such as sumatriptan plus naproxen, have been shown to be effective in the acute treatment of migraine headaches, with a greater effect than either monotherapy alone, but with more common adverse events 8.