Childs MigaineOverview

Migraine headaches can be a very common occurrence in children and the incidence only increases with age. It has been reported that around 3% of children aged three to seven, and up to 23% of children over 11 years old experience migraine headaches.


Migraines are more common in boys before puberty while girls tend to have more migraines after puberty. Treatment of migraines in children is very similar to that of adults. The most commonly recommended medications include NSAIDs (e.g. ibuprofen, naproxen), acetaminophen, triptan drugs.


When children experience four or more migraines per month, prophylaxis is recommended.  The goals of prevention therapy are to reduce the frequency and intensity of these migraines, improve quality of life, and reduce need for acute treatment. Unfortunately, there are few treatments have shown consistent efficacy in the pediatric population.


Most of the studies performed have been small or are poorly designed. Furthermore, results from adult trials can’t necessarily be extrapolated to the pediatric population as there are significant differences between in the physiology between children and adults.


Non-Drug Prevention


In addition to drug therapy for prevention, it’s important to consider how best to minimize certain factors that may bring on migraines in children.

  • Avoid caffeine!
  • Stay well hydrated
  • Get enough sleep
  • Do not miss meals
  • Avoid specific triggers

Drug Prevention For Migraines In Children


Elavil (Amitriptyline)

​Usual Dose

  • 10-25 mg at bedtime

​How Well Does It Work

  • Reduces migraine attacks by almost 50%
  • Reduces severity of migraines on a subjective pain assessment scale
Side Effects

  • ​Drowsiness​
  • Dry mouth
Additional Comments

  • Usually considered a first line therapy
  • ​Long history of use and safety

Topamax (Topiramate)

​Usual Dose

  • 50 mg twice a day 

​How Well Does It Work

  • Reduces migraine attacks by at least 50% in studies
  • Almost 20% of patients have a 75% reduction in migraine frequency
​​
Side Effects

  • ​More than one-quarter of patients have some sort of side effect with 20% of patients needing to discontinue the drug due to these side effects
  • Weight loss
  • Reduced concentration
  • ​Numbness or tingling
  • ​Upper respiratory infection
Additional Comments

  • Usually considered a second line therapy
  • ​Only approved for children 12 and older
Depakote (Divalproex)

​Usual Dose

  • 250-1000 mg daily 

​How Well Does It Work

  • Reduces migraine attacks by at least 50% in studies
​​
Side Effects

  • ​Around 10% of patients have side effects
  • ​Nausea/vomiting
  • ​Weight gain
  • ​Dizziness/drowsiness
Additional Comments

  • Usually considered a second line therapy
  • ​Should not be used in females of child bearing age as it causes birth defects


Inderal (Propranolol)

​Usual Dose

  • 20-120 mg daily

​How Well Does It Work

  • Reduces migraine attacks by at least 60% in studies
  • ​Over 50% of patients experience a complete cessation of symptoms
​​
Side Effects

  • Can make asthma worse
  • Dizziness/drowsiness​
Additional Comments

  • Usually considered a second line therapy

Beyond the listed drugs, there are many additional options that can be used in children. Some of these additional options include hormonal contraceptives for females, riboflavin (vitamin B2), magnesium oxide, coenzyme Q10 and SSRI drugs such as fluoxetine.

Prophylaxis is generally stopped after migraines have been controlled for a period of time. Although there are no clear guidelines, many experts recommend stopping therapy after six to 12 months.