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Emerging Pharmacological Treatments for Migraine in the Pediatric Population
Luigi Francesco Iannone1,2, Francesco De Cesaris2, Pierangelo Geppetti1,2
1Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, 50121 Florence, Italy.
Insights
Pediatric migraine treatment lacks robust data, with few approved drugs and high placebo effects. This review examines current evidence and trials for acute and preventative pharmacotherapies in children and adolescents.
Area of Science:
- Neurology
- Pediatrics
- Pharmacology
Background:
- Pediatric headaches, particularly migraine, are common and costly.
- Pediatric migraine differs clinically from adult migraine.
- Limited high-quality clinical trials exist for pediatric primary headache treatments.
Purpose of the Study:
- To review current evidence on pharmacological treatments for pediatric migraine.
- To discuss ongoing clinical trials for acute and preventative migraine therapies in children and adolescents.
Main Methods:
- Literature review of existing studies on pediatric migraine pharmacotherapy.
- Analysis of data from clinical trials investigating acute and preventative treatments.
- Examination of recent advancements like CGRP inhibitors and ditans in the pediatric context.
Main Results:
- Few drugs are indicated for pediatric migraine, with limited evidence guiding treatment choices.
- High placebo effects complicate treatment efficacy assessment in pediatric populations.
- Newer treatments like CGRP inhibitors and ditans show promise but require more pediatric-specific data.
Conclusions:
- There is a significant need for more high-quality research into effective migraine treatments for children and adolescents.
- Current evidence for pharmacotherapy in pediatric migraine is limited, necessitating careful treatment selection.
- Ongoing trials are crucial for advancing the understanding and management of pediatric migraine.
Abstract:
Headaches in children and adolescents have high incidence and prevalence rates, with consequent elevated disability costs to individuals and the community. Pediatric migraine is a disorder with substantial clinical differences compared to the adult form. Few clinical trials have been performed specifically on primary headache in pediatric populations using acute and preventative treatments, often with conflicting findings. The limited high-quality data on the effectiveness of treatments are also due to the high placebo effect, in terms of reductions in both the frequency and intensity of migraine attacks in the pediatric population. The recent introduction of calcitonin gene-related peptide (CGRP) pathway inhibitors and ditans is changing the treatment of migraine, but the majority of the data are still limited to adulthood. Thus, few drugs have indications for migraine treatment in the pediatric age group, and limited evidence gives guidance as to the choice of pharmacotherapy. Herein, we review the current evidence of pharmacological treatments and ongoing clinical trials on acute and preventative treatments in the pediatric population with migraine.
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