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Drug treatment of migraine in children: a comparative review
1Department of Neurology, University of Münster, Germany. everss@uni-muenster.de
Insights
Effective acute migraine treatments for children include ibuprofen and acetaminophen. For prophylaxis, flunarizine shows efficacy, though other options have mixed results and potential side effects like drowsiness.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Migraine affects 3-7% of children, yet research on pediatric treatment lags behind adult studies.
- Limited controlled trials exist for both acute and prophylactic migraine management in children.
Purpose of the Study:
- To review the efficacy and safety of acute and prophylactic migraine treatments in children.
- To identify evidence-based treatment options for pediatric migraine.
Main Methods:
- Systematic review of controlled trials investigating acute and prophylactic migraine medications in pediatric populations.
- Analysis of drug efficacy, dosage, adverse effects, and comparison with placebo or standard treatments.
Main Results:
- Ibuprofen (10 mg/kg) and acetaminophen (15 mg/kg) are effective for acute pediatric migraine with few side effects.
- Flunarizine (5 mg/day) is the only prophylactic drug with consistent evidence of efficacy from multiple trials.
- Other prophylactic agents like propranolol and pizotifen show contradictory results; oral sumatriptan is generally ineffective.
Conclusions:
- Ibuprofen and acetaminophen are recommended for acute pediatric migraine.
- Flunarizine is a viable option for migraine prophylaxis in children.
- Further high-quality research is needed to establish effective treatments for pediatric migraine, especially for prophylactic strategies.
Abstract:
Migraine according to the criteria of the International Headache Society, occurs in about 3 to 7% of all children. Despite this high incidence, and unlike the situation with adult migraine, only a very few controlled trials have investigated the acute and prophylactic treatment of migraine in children. In the acute migraine attack, ibuprofen 10 mg/kg and paracetamol (acetaminophen) 15 mg/kg have been shown to be effective, with only a few adverse effects. In severe migraine attacks, dihydroergotamine mesylate (dihydroergotamine) administered orally (20 to 40 microg/kg) or intravenously (maximum 1 mg/day) may be helpful, but there have been no large placebo-controlled trials of this treatment. Oral sumatriptan has not been effective in several double-blind and placebo-controlled trials; administered subcutaneously, this drug might be helpful but the only data for this application come from open trials. For migraine prophylaxis, only flunarizine 5 mg/day has been shown to be effective in more than 1 double-blind, placebo-controlled trial. Some evidence also exists that propranolol >60 mg/day and pizotifen 0.5 to 1.5 mg/day are effective; however, the results from different trials are contradictory. For all other drugs studied in migraine prophylaxis, the results remain vague (e.g. amitriptyline, nimodipine, trazodone) or suggest inefficacy (e.g. timolol, clonidine, tryptophan). In migraine-related disorders, pizotifen 0.5 to 0.75 mg/day for abdominal migraine and flunarizine 10 to 25 mg/day for alternating hemiplegia have been shown to be effective. Most of the drugs used in the treatment of migraine in children are well tolerated and without relevant adverse effects. In migraine prophylaxis, the most common adverse effects are drowsiness and bodyweight gain.