Migraine in Children

Migraine in Children

By: Deena E. Kuruvilla, MD, and Brooklyn A. Bradley, BS

While there has been an explosion of options for the treatment of migraine in adults, many of these new treatment options are not recommended for children. Migraine occurs in almost 10% of children (1). As children grow older, the incidence of migraine increases to 15% by age 15 (2).  Migraine is a common reason for absences and not performing optimally in school. Before puberty, migraine is more common in boys and after puberty, it is more common in girls (3). Children not only complain of headache with a migraine attack, but also colic, motion sickness, pain in the stomach, nausea or vomiting. The headache they experience is usually on both sides of the head as opposed to adults who experience pain on one side more commonly. 

For the prevention of migraine in children, amitriptyline with cognitive behavioral therapy (CBT) is recommended by pediatric headache specialists based on existing evidence (4). Amitriptyline is a tricyclic antidepressant medication and CBT is a type of talk therapy which is done with the help of a mental health professional. CBT helps transform negative thinking to positive thinking and has been studied in clinical trials for migraine prevention. In a clinical trial in 2013, researchers investigated the use of CBT plus amitriptyline for chronic migraine in children and adolescents (4). They found that among children and adolescents with chronic migraine, the use of CBT and amitriptyline caused a greater reduction in days with migraine-related disability when compared to headache education and amitriptyline (4). Topiramate, cinnarizine and propranolol may also be considered for prevention (5). 

For the acute treatment of migraine, non-steroidal anti-inflammatory medications (NSAIDS) such as ibuprofen and nausea medications such as metoclopramide may be considered. Migraine specific acute treatments such as sumatriptan, almotriptan, zolmitriptan and rizatriptan are also FDA approved for use in children aged 12 and above (6). The Nerivio device has been studied and approved for use in adolescents and adults for the acute treatment of migraine (7). It is worn on the upper arm as a band and operated from a smartphone. The device transmits electrical pulses over the skin to modulate pain pathways which in turn blocks migraine pain. This device tends to be better tolerated than medications (7). 

In addition to using mainstream approaches, it is important to also consider integrative medicine approaches such as magnesium and riboflavin (8). These vitamins have been studied for migraine prevention and have a limited side effect profile..

There is no substitute for maintaining a healthy lifestyle. Regular and restful sleep, hydration, exercise, a healthy diet and stress management are important factors to also target for the successful management of migraine in children. 

At the Westport Headache Institute, we offer individualized treatment approaches for our younger patients which include mainstream medications as well as natural treatment options.

References:

1. Koller, Lydia Stella, et al. “Quality of Life in Children and Adolescents with Migraine: An Austrian Monocentric, Cross-Sectional Questionnaire Study.” BMC Pediatrics, vol. 19, no. 1, May 2019, p. 164. BioMed Central, https://doi.org/10.1186/s12887-019-1537-0.
2. Antonaci, Fabio, et al. “The Evolution of Headache from Childhood to Adulthood: A Review of the Literature.” The Journal of Headache and Pain, vol. 15, no. 1, 2014, p. 15. PubMed Central, https://doi.org/10.1186/1129-2377-15-15.
3. Allais, Gianni, et al. “Gender-Related Differences in Migraine.” Neurological Sciences, vol. 41, no. 2, Dec. 2020, pp. 429–36. Springer Link, https://doi.org/10.1007/s10072-020-04643-8.
4. Powers, Scott W., et al. “Cognitive Behavioral Therapy Plus Amitriptyline for Chronic Migraine in Children and Adolescents: A Randomized Clinical Trial.” JAMA, vol. 310, no. 24, Dec. 2013, pp. 2622–30. Silverchair, https://doi.org/10.1001/jama.2013.282533.
5. ASHRAFI, Mahmoud Reza, et al. “Cinnarizine versus Topiramate in Prophylaxis of Migraines among Children and Adolescents: A Randomized, Double-Blind Clinical Trial.” Iranian Journal of Child Neurology, vol. 8, no. 4, 2014, pp. 18–27. PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307364/.
6. “Research Summary: Acute Treatment of Migraine in Children and Adolescents.” American Headache Society, https://americanheadachesociety.org/news/acute-treatment-migraine-children/. Accessed 6 Sept. 2022.
7. “#1 Prescribed Drug Free Treatment for Migraine.” Nerivio, https://nerivio.com/. Accessed 6 Sept. 2022.
8. Wells, Rebecca Erwin, et al. “Complementary and Integrative Medicine for Episodic Migraine: An Update of Evidence from the Last 3 Years.” Current Pain and Headache Reports, vol. 23, no. 2, Feb. 2019, p. 10. PubMed Central, https://doi.org/10.1007/s11916-019-0750-8.