The pharmacological treatment options for pediatric migraine: An evidence-based appraisal

Abstract

Summary:The treatment of children and adolescents who suffer from migraine headaches must be individually tailored, flexible, and balanced with a blend of bio-behavioral measures, agents for acute treatment and, if needed, daily preventive medicines. While controlled data is limited, there is now enough evidence available to provide a rational framework to build treatment plans appropriate for the pediatric population. Essentially, the pharmacological management of pediatric migraine divides into agents for the acute attacks and agents used daily to prevent or reduce the frequency of attacks. For the acute treatment, the most rigorously studied agents are ibuprofen, acetaminophen, and the nasal spray forms of sumatriptan and zolmitriptan, all of which have shown both safety and efficacy in controlled trials. For preventive treatment the calcium channel blocker flunarezine has the best efficacy profile in controlled trials, but is not available in the U.S. A growing body of data, mostly uncontrolled, is emerging regarding the use of several anti-epileptic agents (e.g. topiramate, disodium valproate, levateracetam), as well as the antihistamine cyproheptadine and the anti-depressant amitriptyline.

Evolution of paediatric off‐label use after new significant medicines become available for adults: a study on triptans in Finnish children 1994–2007

“…This has been the case although triptans represented a therapeutic benefit over existing treatments and migraine is not uncommon in the paediatric population. No official recommendations on triptan use in children were given during the study period, but several papers reviewing the treatment options and medical trials were published [18][19][20][21][22][23][24][25].…”

Migraine with Aura or Sports-Related Concussion: Case Report, Pathophysiology, and Multidisciplinary Approach to Management

“…Selected triptans also are approved for use in children as abortive medications. In patients with more frequent or severe headaches, prophylactic pharmacological management is considered using medications such as beta-blockers, tricyclic antidepressants, and anticonvulsants (9,42).…”

Studies on the Pathophysiology and Genetic Basis of Migraine

“…Variation in this gene is particularly interesting because estrogen receptors have been implicated in disease processes in breast cancer, endometrial cancer, and osteoporosis and the ESR1 SNP rs2228480 was previously found to show association with breast cancer [140]. ESR1 is localized to chromosome 6q25.1 and is expressed in many areas of the brain regulating many functions including regulating gene expression through cell signalling affecting glutamate and serotonin synthesis and CGRP and can regulate vascular tone by stimulating release of NO [141, 142]. …”