New Guidelines for Treating Pediatric Migraine Released

Both ibuprofen and acetaminophen are safe and effective for treating migraine headaches in children and adolescents, according to the American Academy of Neurology and the Child Neurology Society, whose new practice guideline is published in the December 28 issue of Neurology, the scientific journal of the American Academy of Neurology. The guideline has been endorsed by the American Academy of Pediatrics and the American Headache Society.

Among adolescents, sumatriptan nasal spray was also found to be a safe and effective method for migraine treatment, according to the complete review of related studies published during the last 20 years. However, none of the oral triptan medications were found to be effective in treating migraine in children and adolescents.

Migraine headaches are common in children, with the average age of onset at 7 for boys and 11 for girls. The frequency of migraine increases through adolescence. An estimated 8 percent to 23 percent of children aged 11 to 15 experience migraine, according to lead author Donald W. Lewis, MD, with the Children’s Hospital of the King’s Daughters, Norfolk, Va.

“As pediatric neurologists we are confident that the most common pharmacological headache treatments given to adults are also safe and effective for children,” said Lewis.

Through the evaluation of more than 166 articles and abstracts that addressed children as young as age 3 and up to age 18, neurologists examined the literature to find the most effective medicines to treat migraine attacks and to prevent attacks for children with frequent migraines. The authors determined that there is insufficient evidence to make recommendations concerning use of preventive agents such as cyproheptadine, amitriptyline, divalproex sodium, topiramate, or levetiracetam. The guideline panel found conflicting outcomes regarding the use of propranalol or trazodone for prevention of migraine, and made no recommendations for its use.

Migraine headaches in children and adolescents are usually inherited. Other health conditions, such as stress, anxiety, and depression, environmental causes, and food ingredients may precipitate or aggravate migraine attacks.

Complete guidelines, a summary for physicians, and a version for patients and their families will be available for downloading on December 28 at www.aan.com/professionals/practice/guideline/index.cfm.