Managing Migraine in Pediatric Populations

Migraine is an acute recurrent headache usually lasting from 2 to 48 hours.¹ It occurs in approximately 3% of preschool children, 4% to 11% of elementary school-aged children, and 8% to 15% of high school-aged children.¹

There are mainly 2 types of migraine that occur in children: one without an aura (common migraine), which occurs in 60% to 85% of children, and one with an aura (classic migraine), which occurs in 15% to 30%.¹

Migraine treatment in children

Usually, treatment for children's headaches requires they remain at home and rest, with limited sound disturbances, plenty of fluids, balanced meals, and OTC pain relievers.² If the child is older and has frequent headaches, learning to relax and manage stress through different forms of therapy may help as well.³

Some OTC nonsteroidal anti-inflammatory drugs (NSAIDs) or combination analgesics can be used to treat migraine in children. It is important to provide early treatment and provide the appropriate dose based on weight without overusing the medication.²

Typically, it’s recommended not to use analgesics more than 2 to 3 times a week.² A daily dose of 7.5 mg/kg to 10 mg/kg of the NSAID ibuprofen for the treatment of acute mild to moderate childhood headaches is recommended, although the NSAID aspirin isn’t generally used due to the risk of Reye syndrome.²

Another treatment option is using a drug from the triptan class. Sumatriptan succinate’s dose of 0.06 mg/kg, for example, was found to have an overall efficacy of 72% at 30 minutes and 78% at 2 hours, with a low recurrence rate of 6%.² However, children usually reject injection, which makes the use of the subcutaneous form of sumatriptan limited when treating children.²

In addition, treatment with rochlorperazine maleate and metoclopramide hydrochloride can also be used for children with symptoms of nausea and vomiting from migraine headaches.²

Prevention

If children experience 3 to 4 headaches a month, a preventive therapy will usually be necessary.² Even though some medications have been tested in children for migraine prevention, the FDA has not approved any of these medications yet.

Tricyclic antidepressants such as amitriptyline is most commonly used to prevent migraine, with a dose of 1 mg/kg/day of amitriptyline resulting in an improvement in headache frequency in more than 80% of the children.² However, this dose should be slowly titrated over 8 to 10 weeks so that the child can slowly tolerate the adverse effects of the medication.²

Another option is anticonvulsant therapy. In a recent study, researchers found that 31 children aged 7 to 16 years were responsive to the 15 mg/kg to 45 mg/kg dosage of divalproex sodium. Overall, 76% of patients had a greater than 50% reduction in migraine frequency, 18% had a greater than 75% reduction, and 6% were migraine-free.²

Non-pharmaceutical medication treatment

Maintaining healthy lifestyle habits can help improve the outcome and reduce migraine in children. Healthy lifestyle habits include the maintenance of adequate fluid hydration, regular exercise programs, not skipping meals, eating a balanced and healthy diet, and maintaining adequate sleep.²

Relaxation techniques, such as deep breathing, yoga, and meditation, may be beneficial in reducing migraine episodes in children as well. Biofeedback training can also be helpful in teaching children to cope with migraine pain, as it helps them control certain body responses to reduce pain. In addition, cognitive behavioral therapy may help a child learn to manage stress in order to see if that may help to reduce the frequency and severity of migraines.³

Alternative medicine

Any alternative medicine treatment methods for treating migraine in children is important to discuss with a child's physician prior to trying the product. However, there are some dietary supplements that have been suggested to help children's migraines, such as riboflavin, magnesium, coenzyme Q10, vitamin D, and melatonin.³

REFERENCES

• Cleveland Clinic. Migraines in Children and Adolescents. https://my.clevelandclinic.org/health/diseases/9637-migraines-in-children-and-adolescents . Accessed January 20, 2021.
• Andrew Hershey, Paul Winner. Pediatric Migraine: Recognition and Treatment. JAOA. https://jaoa.org/article.aspx?articleid=2093039 . Accessed January 20, 2021.
• Mayo Clinic. Headache in Children. https://www.mayoclinic.org/diseases-conditions/headaches-in-children/diagnosis-treatment/drc-20352104 . Accessed January 25, 2021.