Acute and Preventive Treatment of Migraine in Adolescent Females

Acute Treatment

The American Academy of Neurology recommends ibuprofen (10 mg/kg) as the first-line medication for acute migraine treatment in adolescents, which should be administered early in the attack for maximum effectiveness 1
The American Headache Society suggests that ibuprofen has the strongest evidence as an initial treatment in pediatric and adolescent populations 2, 1
For mild attacks, bed rest may be sufficient in some cases, according to the American Academy of Neurology 3, 1
The combination of sumatriptan and naproxen oral is recommended for adolescents with moderate to severe attacks or those who do not respond to nonsteroidal anti-inflammatory drugs (NSAIDs), as per the American College of Neurology 1
Zolmitriptan nasal spray is an option for moderate to severe attacks, as recommended by the American Headache Society 1
Sumatriptan nasal spray is also an option for moderate to severe attacks, according to the American Academy of Neurology 1

The American Academy of Neurology recommends considering preventive treatment in adolescents with frequent, disabling headaches, or medication overuse, with propranolol (80-160 mg daily) as the first-line preventive medication with the strongest evidence 1, 3, 4
Topiramato (50-100 mg oral daily) and amitriptilina (10-100 mg oral nightly) are alternative first-line preventives, as suggested by the American Headache Society 3
Flunarizina (5-10 mg daily) is a second-line treatment if propranolol fails or is not tolerated, according to the American College of Neurology 3, 4

The American College of Obstetricians and Gynecologists recommends considering perimenstrual preventive treatment if attacks are related to menstruation, typically with NSAIDs (naproxen) or triptans (frovatriptán or naratriptán) for 5 days, starting 2 days before the expected first day of menstruation 3
Combined hormonal contraceptives are contraindicated in women with migraine with aura due to the increased risk of stroke, as per the American Headache Society 3
When prescribing topiramato or valproato to women of childbearing age, discuss teratogenic effects and recommend effective contraceptive methods and folate supplementation, according to the American Academy of Neurology 4
Valproato is absolutely contraindicated in women of childbearing age, as recommended by the American College of Neurology 3

Evaluate treatment effectiveness 2-3 months after initiation or change of treatment, using headache calendars to document attack frequency, severity, and disability, as suggested by the American Headache Society 3, 4
Define treatment success as a ≥50% reduction in attack frequency, according to the American Academy of Neurology 4

Do not declare treatment failure before allowing 2-3 months for clinical benefit to manifest, as recommended by the American College of Neurology 4
Educate patients and families to treat attacks early for better results, according to the American Headache Society 1
Discuss with patients and families that in many trials, placebo was as effective as preventive medications, particularly in pediatric populations, as per the American Academy of Neurology 1, 4