Preventive treatment of migraine in children
- Kenneth J Mack, MD, PhD
Kenneth J Mack, MD, PhD
- Professor of Neurology and Pediatrics
- Mayo Medical School
- Section Editors
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Jerry W Swanson, MD, MHPE
Jerry W Swanson, MD, MHPE
- Section Editor — Headache
- Professor of Neurology
- Mayo Clinic College of Medicine
Migraine is a common acute and recurrent headache syndrome in children. It is characterized by severe periodic episodes of headache accompanied by nausea, vomiting, photophobia, and phonophobia, and relieved with sleep. In children, it may last from 2 to 72 hours (sometimes shorter), is often bilateral, and often occurs without aura .
The management of migraine consists of general lifestyle measures, abortive treatment, and preventive treatment. An individual patient may need all three approaches. Unfortunately, there are limited data from controlled, randomized, and blinded trials regarding treatment of migraine in children and adolescents [2-4]. Thus, most management recommendations are based upon experience in adults.
The preventive treatment of migraine in children is reviewed here. Other aspects of pediatric migraine are discussed separately. (See "Classification of migraine in children" and "Pathophysiology, clinical features, and diagnosis of migraine in children" and "Acute treatment of migraine in children".)
Indications for preventive therapy of migraine include the following:
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- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
- Lewis D, Ashwal S, Hershey A, 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 2004; 63:2215.
- El-Chammas K, Keyes J, Thompson N, et al. Pharmacologic treatment of pediatric headaches: a meta-analysis. JAMA Pediatr 2013; 167:250.
- O'Brien HL, Kabbouche MA, Hershey AD. Treating pediatric migraine: an expert opinion. Expert Opin Pharmacother 2012; 13:959.
- Metsähonkala L, Sillanpää M, Tuominen J. Headache diary in the diagnosis of childhood migraine. Headache 1997; 37:240.
- Arruda MA, Bigal ME. Migraine and migraine subtypes in preadolescent children: association with school performance. Neurology 2012; 79:1881.
- Agency for Healthcare Research and Quality. U.S. Department of Health and Human Services. Migraine in children: Preventive pharmacologic treatments. Comparative Effectiveness Review Number 108. June 2013. http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1515 (Accessed on June 17, 2013).
- Shamliyan TA, Kane RL, Ramakrishnan R, Taylor FR. Episodic migraines in children: limited evidence on preventive pharmacological treatments. J Child Neurol 2013; 28:1320.
- Bille B, Ludvigsson J, Sanner G. Prophylaxis of migraine in children. Headache 1977; 17:61.
- Lewis DW, Diamond S, Scott D, Jones V. Prophylactic treatment of pediatric migraine. Headache 2004; 44:230.
- Worawattanakul M, Rhoads JM, Lichtman SN, Ulshen MH. Abdominal migraine: prophylactic treatment and follow-up. J Pediatr Gastroenterol Nutr 1999; 28:37.
- Watemberg NM, Roth KS, Alehan FK, Epstein CE. Central anticholinergic syndrome on therapeutic doses of cyproheptadine. Pediatrics 1999; 103:158.
- Forsythe WI, Gillies D, Sills MA. Propanolol ('Inderal') in the treatment of childhood migraine. Dev Med Child Neurol 1984; 26:737.
- Olness K, MacDonald JT, Uden DL. Comparison of self-hypnosis and propranolol in the treatment of juvenile classic migraine. Pediatrics 1987; 79:593.
- Ludvigsson J. Propranolol used in prophylaxis of migraine in children. Acta Neurol Scand 1974; 50:109.
- Powers SW, Coffey CS, Chamberlin LA, et al. Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine. N Engl J Med 2017; 376:115.
- Winner PK. Headaches in children. When is a complete diagnostic workup indicated? Postgrad Med 1997; 101:81.
- Hershey AD, Powers SW, Bentti AL, Degrauw TJ. Effectiveness of amitriptyline in the prophylactic management of childhood headaches. Headache 2000; 40:539.
- Lewis DW, Winner P, Wasiewski W. The placebo responder rate in children and adolescents. Headache 2005; 45:232.
- Faria V, Linnman C, Lebel A, Borsook D. Harnessing the placebo effect in pediatric migraine clinic. J Pediatr 2014; 165:659.
- Battistella PA, Ruffilli R, Cernetti R, et al. A placebo-controlled crossover trial using trazodone in pediatric migraine. Headache 1993; 33:36.
- Winner P, Pearlman EM, Linder SL, et al. Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. Headache 2005; 45:1304.
- Lewis D, Winner P, Saper J, et al. Randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of topiramate for migraine prevention in pediatric subjects 12 to 17 years of age. Pediatrics 2009; 123:924.
- Lebow J, Chuy JA, Cedermark K, et al. The development or exacerbation of eating disorder symptoms after topiramate initiation. Pediatrics 2015; 135:e1312.
- Apostol G, Cady RK, Laforet GA, et al. Divalproex extended-release in adolescent migraine prophylaxis: results of a randomized, double-blind, placebo-controlled study. Headache 2008; 48:1012.
- Loiseau P. Sodium valproate, platelet dysfunction, and bleeding. Epilepsia 1981; 22:141.
- Vikelis M, Rapoport AM. Role of antiepileptic drugs as preventive agents for migraine. CNS Drugs 2010; 24:21.
- Belman A, Milazo M, Savatic M, Gabis L. Gabapentin for migraine prophylaxis in children (abstract). Ann Neurol 2001; 50:S109.
- Miller GS. Efficacy and safety of levetiracetam in pediatric migraine. Headache 2004; 44:238.
- Sorge F, De Simone R, Marano E, et al. Flunarizine in prophylaxis of childhood migraine. A double-blind, placebo-controlled, crossover study. Cephalalgia 1988; 8:1.
- Victor S, Ryan SW. Drugs for preventing migraine headaches in children. Cochrane Database Syst Rev 2003; :CD002761.
- Garaizar C, Prats JM, Zuazo E. [Response to prophylactic treatment of benign headache in children]. Rev Neurol 1998; 26:380.
- Ashrafi MR, Salehi S, Malamiri RA, et al. Efficacy and safety of cinnarizine in the prophylaxis of migraine in children: a double-blind placebo-controlled randomized trial. Pediatr Neurol 2014; 51:503.
- Orr SL, Venkateswaran S. Nutraceuticals in the prophylaxis of pediatric migraine: Evidence-based review and recommendations. Cephalalgia 2014; 34:568.
- MacLennan SC, Wade FM, Forrest KM, et al. High-dose riboflavin for migraine prophylaxis in children: a double-blind, randomized, placebo-controlled trial. J Child Neurol 2008; 23:1300.
- Condò M, Posar A, Arbizzani A, Parmeggiani A. Riboflavin prophylaxis in pediatric and adolescent migraine. J Headache Pain 2009; 10:361.
- Bruijn J, Duivenvoorden H, Passchier J, et al. Medium-dose riboflavin as a prophylactic agent in children with migraine: a preliminary placebo-controlled, randomised, double-blind, cross-over trial. Cephalalgia 2010; 30:1426.
- Sherwood M, Goldman RD. Effectiveness of riboflavin in pediatric migraine prevention. Can Fam Physician 2014; 60:244.
- Powers SW, Kashikar-Zuck SM, Allen JR, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA 2013; 310:2622.
- Sartory G, Müller B, Metsch J, Pothmann R. A comparison of psychological and pharmacological treatment of pediatric migraine. Behav Res Ther 1998; 36:1155.
- Stubberud A, Varkey E, McCrory DC, et al. Biofeedback as Prophylaxis for Pediatric Migraine: A Meta-analysis. Pediatrics 2016; 138.
- Prensky AL. Headache. In: Oski's Pediatrics. Principles and Practice, 4th ed, McMillan JA, Feigin RD, DeAngelis C, Jones MD (Eds), Lippincott, Williams & Wilkins, Philadelphia 2006. p.2388.
- Connelly M. Cognitive behavioral therapy for treatment of pediatric chronic migraine. JAMA 2013; 310:2617.
- Bille B. Migraine in childhood and its prognosis. Cephalalgia 1981; 1:71.
- Cologno D, Torelli P, Manzoni GC. Migraine with aura: a review of 81 patients at 10-20 years' follow-up. Cephalalgia 1998; 18:690.
- Bille B. A 40-year follow-up of school children with migraine. Cephalalgia 1997; 17:488.
- Hernandez-Latorre MA, Roig M. Natural history of migraine in childhood. Cephalalgia 2000; 20:573.
- Monastero R, Camarda C, Pipia C, Camarda R. Prognosis of migraine headaches in adolescents: a 10-year follow-up study. Neurology 2006; 67:1353.
- Galinski M, Sidhoum S, Cimerman P, et al. Early Diagnosis of Migraine Necessary in Children: 10-Year Follow-Up. Pediatr Neurol 2015; 53:319.
- LIFESTYLE MEASURES
- PHARMACOLOGIC TREATMENT
- Other antidepressants
- Other anticonvulsants
- BEHAVIORAL INTERVENTIONS
- MENSTRUAL MIGRAINE
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS