Migraine Treatment in an 8-Year-Old Girl
For acute migraine attacks in an 8-year-old, ibuprofen 7.5–10 mg/kg (maximum 400 mg per dose) is the first-line medication and should be given as early as possible at headache onset. 1, 2
Acute Treatment Protocol
First-Line Medication
- Ibuprofen is the primary acute treatment with the strongest evidence in pediatric migraine, dosed at 7.5–10 mg/kg (typically 200–400 mg for an 8-year-old) at the first sign of headache. 1, 2
- Acetaminophen 15 mg/kg (maximum 1000 mg) is an alternative if ibuprofen is contraindicated, though evidence for efficacy is weaker. 3, 2
- Administer medication early in the attack while pain is still mild to maximize effectiveness. 1, 2
Managing Nausea and Vomiting
- If nausea or vomiting is present, domperidone can be given as an adjunct 20–30 minutes before the analgesic to improve absorption and provide antiemetic effect. 1
- When oral medications cannot be tolerated due to severe vomiting, intranasal sumatriptan 5–20 mg is the most effective non-oral option for children. 1
Second-Line Options (If Ibuprofen Fails After 2–3 Episodes)
- Intranasal sumatriptan is appropriate for moderate to severe attacks unresponsive to NSAIDs, though evidence is stronger in adolescents than younger children. 1, 2
- Oral sumatriptan combined with naproxen has high-confidence evidence in adolescents but limited data in children under 12 years. 2
Critical Frequency Limitation
- Limit all acute medications to no more than 2 days per week to prevent medication-overuse headache, which can develop even in children. 1
- If the child requires treatment more than twice weekly, preventive therapy should be initiated rather than increasing acute medication frequency. 1
When to Consider Preventive Therapy
- Preventive therapy is indicated when attacks occur more than 2 days per month and significantly impair quality of life despite optimized acute treatment. 1, 4
- First-line preventive options in children include propranolol (beta-blocker), amitriptyline (tricyclic antidepressant), or topiramate (antiepileptic), though specific pediatric dosing requires specialist guidance. 4
Pediatric-Specific Considerations
- Migraine in children is often shorter in duration (2–72 hours), more bilateral, and has prominent gastrointestinal symptoms (nausea, vomiting, abdominal pain) compared to adults. 1, 5
- Children may have difficulty verbalizing symptoms like photophobia and phonophobia, which must be inferred from behavior (seeking dark, quiet rooms; stopping activities). 5, 6
Non-Pharmacological Measures
- Ensure regular meals, adequate hydration, and consistent sleep schedules to reduce trigger exposure. 1
- Identify and avoid specific triggers (certain foods, stress, lack of sleep, excessive screen time). 2
- Educate both parents and teachers about migraine management to support the child during attacks. 1
Red Flags Requiring Urgent Evaluation
- First or worst headache ever, recent onset with increasing severity, awakening from sleep due to headache, headache exclusively in the morning with severe vomiting, or any focal neurological signs warrant immediate neuroimaging. 6
When to Refer to Specialist
- Refer to pediatric neurology or headache specialist if acute medications provide insufficient relief after adequate trials of both ibuprofen and intranasal sumatriptan, or if preventive therapy is needed. 1