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Preventive therapy in pediatric migraine
1Mayday Pediatric Headache Center, Lancaster, PA 17601, USA. wwwasiew@lha.org
Insights
Preventive therapy for pediatric migraine is limited, but amitriptyline and divalproex sodium show potential efficacy in open-label studies. Further research is needed to establish optimal treatment strategies for children experiencing frequent headaches.
Area of Science:
- Neurology
- Pediatric Medicine
- Pharmacology
Background:
- Migraine headache prevention involves identifying triggers, lifestyle changes, acute headache management, and pharmacologic agents.
- Limited well-controlled clinical trials exist for pediatric migraine prophylaxis.
Purpose of the Study:
- To review the current literature on migraine prophylaxis in children.
- To present dosing guidelines based on available data and clinical experience.
Main Methods:
- Review of pertinent literature on migraine prophylaxis in children.
- Analysis of open-label studies on amitriptyline and divalproex sodium.
Main Results:
- No well-controlled trials support agents for pediatric migraine prevention.
- Open-label studies suggest potential efficacy for amitriptyline and divalproex sodium.
- Mechanisms may involve 5-hydroxytyptamine-2 (5-HT2) receptor antagonism or ion channel regulation.
Conclusions:
- Pharmacologic options for pediatric migraine prophylaxis are limited.
- Amitriptyline and divalproex sodium show promise but require further investigation.
- Dosing guidelines are provided based on limited evidence and clinical expertise.
Abstract:
Preventive therapy for migraine headache includes identification of migraine precipitants, possible adjustments in lifestyle, appropriate management of acute headache, and, when necessary, the use of pharmacologic agents. There are no well-controlled clinical trials with sufficient patient numbers to support the use of any agent in the prevention of migraine headache in children. Data on the use of amitriptyline and divalproex sodium in open-label studies suggest that these agents may be efficacious. The mechanism of action for these agents is unknown but may be related to the 5-hydroxytyptamine-2 (5-HT2) receptor antagonism or regulation of ion channels. A review of the pertinent literature on migraine prophylaxis in children is presented. Dosing guidelines are presented based on the limited data available and clinical experience.