Treatment of Acute Migraine Attacks in Children
First-Line Treatment Options
- The American Academy of Neurology recommends ibuprofen (10 mg/kg) as the first-line medication for treating pain in both children and adolescents with acute migraine attacks 1, 2
- Treatment should be administered early in the migraine attack for maximum effectiveness 1, 2
- For mild attacks in young children, bed rest alone might be sufficient in some cases 3
Second-Line Treatment Options for Adolescents
- For adolescents with moderate to severe attacks or those who don't respond to NSAIDs, consider sumatriptan/naproxen oral combination 1, 2
- Zolmitriptan nasal spray is an option for adolescents with moderate to severe attacks 1, 2, 3
- Sumatriptan nasal spray is an option for adolescents with moderate to severe attacks 1, 2, 3
Special Clinical Situations
- For rapidly escalating headache pain, consider non-oral triptan formulations (nasal sprays) 1, 2
- For attacks with significant nausea or vomiting, use non-oral triptan formulations 1, 2
- For adolescents aged 12-17 years, domperidone can be used for nausea 3
Treatment Failure Management
Important Considerations and Cautions
- Counsel patients and families to treat migraine attacks early for best results 1, 2
- Warn about medication overuse, which can occur with frequent use of acute medications (≥15 days/month with NSAIDs or ≥10 days/month with triptans) 4, 5
- The evidence base for medication therapy in children is complicated by high placebo response rates in clinical trials 3
- Nasal spray formulations of triptans appear to be most effective in adolescents 3
When to Consider Preventive Treatment
- Consider preventive treatments in children and adolescents with frequent headaches, disabling headaches, or medication overuse 1, 2
- Discuss with patients and families that in many trials, placebo was as effective as the studied preventive medications 1, 2
- Options for prevention include amitriptyline, topiramate, and propranolol 1, 2