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Treating Migraines in Children

Guidelines for Medical Solutions

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Updated January 28, 2009

With all the available choices, finding the best option for treating migraines in children can be daunting. The old adage “children are not just little adults” is quite appropriate, and it is important to exercise caution when treating children. Some guidelines are available to healthcare providers when it comes to treating children with migraines.

Over-the Counter Medications for Acute Migraines

Most studies involving treating migraines in children relate to acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). Both are available over the counter, and both are relatively safe when used properly. Ibuprofen has been more rigorously studied, and has been shown to be quite effective in treating headaches. Acetaminophen worked a bit faster than ibuprofen, but was not as effective in overall pain reduction.

Naproxen (Naprosyn) is another non-steroidal anti-inflammatory drug (NSAID) that may be used in treating migraines in children. Studies have not yet supported its use before ibuprofen or acetaminophen, but your child’s healthcare provider may feel it is an appropriate choice.

Prescription Medications for Acute Migraines

Few prescription medications are thought to be useful for treating migraines in children. Sumatriptan (Imitrex) (sometimes referred to as one of the “triptan” medications) can be taken by mouth, sprayed into the nose, or injected just under the skin (subcutaneously). Studies show that the nasal spray can be an effective treatment form migraines in adolescents. Besides treating the headache, it may also decrease secondary symptoms like nausea or photophobia. Studies have not supported using sumatriptan orally or subcutaneously in children, however.

Other prescription medications that have studied, but not yet “proven,” as effective treatments for adolescent patients (ages 12 to 18) include other triptan medications like rizatriptan (Maxalt) or zolmitriptan (Zomig). Your child’s healthcare provider may feel one of these medications is the best treatment for him.

Other Considerations

Some research suggests that nausea and vomiting accompany migraines in children up to 90% of the time. For this reason, a number of medications can be used to treat these secondary symptoms. Also, little has been studied about medications that may prevent headaches in children and adolescents. To this point, use of prophylactic medications for migraines is based on anecdotes and practices in adult patients. Discuss any questions or concerns you may have thoroughly with your child’s healthcare provider before filling a prescription for him. Prevention strategies for migraines are similar in children and adults, so consider what lifestyle and dietary changes you can make for your child to decrease the likelihood that he will develop headaches.

Sources:

D. Lewis. Headaches in children and adolescents. Am Fam Physician. 2002 Feb 15;65(4):625-32.

D. Lewis, et al. Practice Parameter: Pharmacological treatment of migraine headache in children and adolescents: Report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology, Dec 2004; 63: 2215 - 2224.

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