How are migraine headaches treated in children and adolescents?
Basic lifestyle changes can help control a migraine. Whenever possible, avoiding the known triggers can help reduce the frequency and severity of migraine attacks.
Biofeedback and stress reduction. Biofeedback helps a person learn stress-reducing skills by providing information about muscle tension, heart rate, and other vital signs as a person attempts to relax. It is used to gain control over certain bodily functions that cause tension and physical pain.
Biofeedback can be used to help patients learn how their body responds in stressful situations, and how to better cope. Some people choose biofeedback instead of medications.
Other stress reduction options include counseling, exercising, and yoga.
Vitamins, minerals, and herbal products. These products have shown some effectiveness in migraine. They include magnesium, riboflavin, and coenzyme Q10.
Medications. Headache medications can be grouped into three different categories: symptomatic relief, abortive therapy, and preventive therapy. Each type of medication is most effective when used in combination with other medical recommendations, such as dietary and lifestyle changes, exercise, and relaxation therapy.
Symptomatic relief. These medicines are used to relieve symptoms associated with headaches, including the pain of a headache or the nausea and vomiting associated with migraine. These medications include simple analgesics (ibuprofen or acetaminophen), anti-emetics (for nausea/vomiting), or sedatives (to help sleep; sleep relieves migraine). Some of these medications may require a prescription; others are available over-the-counter without the need for a prescription, but should only be taken on the advice or recommendation of a physician.
Important: If symptomatic relief medications are used more than twice a week, see your doctor. Overuse of symptomatic medications can actually cause more frequent headaches or worsen headache symptoms. This is called rebound or medication overuse headache.
Abortive therapy. These medications help stop the headache process and prevent migraine symptoms including pain, nausea, and light sensitivity. They are taken at the first sign of a migraine.
Abortive medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs; such as ibuprofen, naproxen)
- The triptan medications sumatriptan succinate (Imitrex®), zolmitriptan (Zomig®), rizatriptan (Maxalt®), almotriptan (Axert®), eletriptan (Relpax®), and the longer-acting triptans frovatriptan (Frova®) and naratriptan (Amerge®)
- Antiemetics (medications that relieve nausea and vomiting) are often used together with the medications listed above.
Preventive therapy__\_._ These medications are taken daily to reduce the frequency and severity of the migraine over time. Some commonly prescribed preventive medications include:
- Antidepressant medications, such as amitriptyline (Elavil®)
- Antihistamines, such as cyproheptadine (Periactin®)
- Anticonvulsant medication, such as topiramate (Topamax®). Divalproex should not be taken by women in child-bearing years.
- Beta blockers, such as propranolol (Inderal®)
- Calcium channel blockers, such as verapamil (Calan® and Isoptin®)
Often a combination of symptomatic and preventive medications may be needed. Patients should be started at a low dose, with the dose slowly increased over time. Medication works best when combined with lifestyle changes and patient education.
What treatment approaches can be tried in children and adolescents with migraine?
Young children: Infrequent migraine
These symptomatic medications are useful:
- Simple analgesics – pain-relieving medications, such as ibuprofen or acetaminophen, but not aspirin
- Antiemetics – medications that relieve nausea and vomiting, such as ondansetron (Zofran®)
- Sedatives—medications that help a child sleep (sleep relieves migraine)
Young children: Frequent migraine
These preventive medications may be prescribed:
- Cyproheptadine (Periactin®), amitriptyline (Elavil®), topiramate (Topamax®), or gabapentin (Neurontin®)
- A combination of symptomatic (from list above) and preventive medications
Adolescents: Infrequent migraine (with or without aura)
These symptomatic medications can be useful:
- Analgesics – pain-relieving medications, such as acetaminophen, ibuprofen, and naproxen
- Antiemetics – medications that relieve nausea and vomiting
- Sedatives – medication, such as diphenhydramine, that helps a patient sleep (sleep relieves migraine)
If symptomatic medications alone are unsuccessful, the following abortive medications can be added the symptomatic medication:
- Triptans (Imitrex®, Zomig®, Amerge®, Maxalt®, Axert®, Frova®, and Relpax®)
Adolescents: Frequent migraine
These preventive medications can be tried:
- Tricyclic antidepressants, antihistamines, anticonvulsants (especially topiramate [Topamax®]), propranolol, or calcium channel blockers may be prescribed (see names of some of these drugs under “preventive therapy of migraine” above).
- A combination of abortive and symptomatic medications.
Adolescents: Severe migraine (unresponsive to other medications and lasting > 24 hours)
Adolescents experiencing severe migraine should be seen by a headache specialist.
When headaches – and especially migraine headaches – last longer than 24 hours and other medications have been unsuccessful in managing the attacks, medication administered in an “infusion suite” can be considered. An infusion suite is a designated set of rooms at a hospital or clinic that are monitored by a nurse and where intravenous drugs are prescribed by a physician. The intravenous drugs are usually able to end the migraine attack. Patients’ length of stay at the infusion suite can range from several hours to all day.