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Published on: June 2, 2014
[Pharmacologic treatment of acute migraine attack in children]
J C Cuvellier1, S Joriot, S Auvin
1Service de neuropédiatrie, clinique de pédiatrie, hôpital Roger-Salengro, centre hospitalier régional et universitaire de Lille, 59037 Lille cedex, France. jc-cuvellier@chru-lille.fr
Insights
Effective acute migraine treatments for children include ibuprofen or paracetamol for mild attacks. Severe attacks may benefit from dihydroergotamine or sumatriptan nasal spray, with few side effects.
Area of Science:
- Pediatric Neurology
- Headache Medicine
Background:
- Migraine affects 5-10% of children, necessitating comprehensive management strategies.
- Treatment involves acute headache management, identifying triggers, lifestyle adjustments, and preventive therapies.
Purpose of the Study:
- To review current management strategies for pediatric migraine.
- To evaluate the efficacy and safety of various acute treatment options for children.
Main Methods:
- Review of existing literature on pediatric migraine treatment.
- Analysis of clinical trial data for acute therapies like ibuprofen, paracetamol, dihydroergotamine, and sumatriptan.
Main Results:
- Ibuprofen (10 mg/kg) and paracetamol (15 mg/kg) are effective for acute pediatric migraine with minimal adverse events.
- Sumatriptan nasal spray shows demonstrated efficacy, with transitory unpleasant taste as the main side effect.
- Dihydroergotamine may be useful for severe attacks, though large placebo-controlled trials are lacking.
Conclusions:
- Pediatric migraine management requires a multi-faceted approach.
- Pharmacological interventions like ibuprofen, paracetamol, and sumatriptan offer effective acute treatment options for children.
- Further research is needed for treatments like dihydroergotamine in severe pediatric migraine cases.
Abstract:
Migraine, according to the criteria of the International Headache Society, occurs in about 5 to 10% of children. Management of acute headache is only one of the parts of the treatment, along with identification of migraine precipitants, adjustments in lifestyle, and when necessary the use of preventive therapy, which can include non pharmacologic (relaxation or biofeedback) or pharmacologic treatment. In the acute migraine attack, a single dose of either ibuprofen 10 mg/kg or paracetamol 15 mg/kg has been shown to be effective, with only a few adverse effects. In severe migraine attacks, dihydroergotamine mesylate 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. Among the different triptans, it is the sumatriptan nasal spray whose efficacy has been best demonstrated. The most frequent adverse event is transitory unpleasant taste.
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