Preventing and Treating Migraines in Children and Adolescents

Scientific Recommendations on Pediatric Migraine

Girl suffering from a headache
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Treating children and adolescents with migraines is challenging. This is because there is limited scientific research on pediatric migraine, which is different from adult migraine.

Let's review what some experts say about treating and preventing migraines in children.

Recommendations from the AAN on Treating Migraine in Children

The American Academy of Neurology (AAN) Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society made recommendations in 2004 for the treatment and prevention of migraines in children and adolescents.

The team identified and studied 166 articles. Based on their review of all the available data, the committee members made the following recommendations:

For acute treatment of migraine attacks:

  • Ibuprofen is effective and should be considered for the acute treatment of migraine attacks in children (over 6 years).
  • Tylenol (acetaminophen) is probably effective and should be considered for the acute treatment of migraine attacks in children.
  • Imitrex/Imigran (Sumatriptan) nasal spray is effective and should be considered for the acute treatment of migraine attacks in adolescents (over 12 years).
  • There was no data, positive or negative, regarding the use of any oral (by mouth) triptans in children or adolescents.
  • There is inadequate data to determine the benefit of subcutaneous (beneath the skin) sumatriptan.

For daily preventive therapy:

  • Flunarizine is probably effective and could be considered but is not available in the United States.
  • There is insufficient evidence to make any recommendations concerning the use of Periactin (cyproheptadine), Elavil (amitriptyline), Depakote (divalproex sodium), Topamax (topiramate), or Keppra (levetiracetam).
  • Because the evidence is conflicting, recommendations cannot be made concerning Inderal (propranolol) or Desyrell (trazodone).
  • Sandomigraine (Pizotifen)and Nimotop (nimodipine) and clonidine did not show benefit and are not recommended.

Other Scientific Thoughts on Treating Pediatric Migraine

The authors of a 2008 article in the Journal of Pediatric Pharmacology and Therapeutics reported that Ibuprofen and Tylenol (acetaminophen) are beneficial and safe for children less than 12 years of age. They also noted that for adolescents, if Ibuprofen and Tylenol (acetaminophen) do not work, a triptan may be considered—despite the fact that triptans are not FDA-approved in adolescents. That being said, only Imitrex (sumatriptan) and Zomig (zolmitriptan) nasal spray have been found to be effective in studies in relieving acute migraines in adolescents.

Other Scientific Thoughts on Preventing Pediatric Migraine

A 2013 study in Jama Pediatrics mostly agrees with the AAN guidelines in that there is no evidence that commonly used preventive medications, like clonidine, pizotifen, propranolol, and valproate, are effective. They also mentioned flunarizine as not being effective compared to placebo, which the AAN thought might be effective. That being said, a significant number of children and teenagers (30 percent reported by one study) with migraine headaches probably require a preventive migraine medication at some point. This only emphasizes the urgent need for large, randomized, placebo-controlled trials on preventing pediatric migraine. 

Behavioral Interventions to Treat Migraines in Children

  • It's important to note that medications should not be the sole therapy for treating migraines in children. Lifestyle habits and identifying and coping with triggers is equally, if not more important.  Examples of ways you can better understand your child's migraines is by linking their attacks with behaviors like:
      • sleep patterns
    • caffeine consumption
    • dietary considerations
    • exercise
    • stress at home and at school
    • overscheduling activities

    A Word From Verywell

    All in all, the take home message here is that there is a significant lack of studies on pediatric migraines, both in preventing them and treating them. That being said, with a balanced medical and behavioral migraine plan, your child can get relief. Remain an advocate for your child's migraine health.
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