The Changing Landscape of Pediatric Migraine Therapy: A Review

JAMA Neurol. 2018 Jul 1;75(7):881-887. doi: 10.1001/jamaneurol.2018.0046.

Abstract

Importance: Migraine is a disabling and prevalent condition that affects the pediatric and adolescent population. This review describes current acute and preventive migraine pharmacologic therapies for the pediatric and adolescent population.

Observations: Multiple pharmacotherapies that have been used in the treatment of acute headache and prevention in pediatric migraine are reviewed. There have been recent advances in the management of migraines among pediatric and adolescent patients, including US Food and Drug Administration approval of triptans for acute management in children as young as 6 years, and the first prospective, randomized, double-blind, placebo-controlled comparative study of preventive pharmacotherapy in pediatric migraine. A major challenge of evidence-based research in pediatric and adolescent migraine is the significant placebo effect.

Conclusions and relevance: Although progress is being made in the management of migraines among pediatric and adolescent patients, there remains much work to be done.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adrenergic beta-Antagonists / therapeutic use
  • Amitriptyline / therapeutic use
  • Analgesics, Non-Narcotic / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Anticonvulsants / therapeutic use
  • Calcium Channel Blockers / therapeutic use
  • Child
  • Cognitive Behavioral Therapy
  • Dihydroergotamine / therapeutic use
  • Dopamine Antagonists / therapeutic use
  • Fluid Therapy
  • Glucocorticoids / therapeutic use
  • Headache Disorders, Secondary
  • Humans
  • Magnesium / therapeutic use
  • Migraine Disorders / prevention & control*
  • Migraine Disorders / therapy
  • Nerve Block
  • Topiramate / therapeutic use
  • Tryptamines / therapeutic use
  • Valproic Acid / therapeutic use

Substances

  • Adrenergic beta-Antagonists
  • Analgesics, Non-Narcotic
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticonvulsants
  • Calcium Channel Blockers
  • Dopamine Antagonists
  • Glucocorticoids
  • Tryptamines
  • Topiramate
  • Amitriptyline
  • Dihydroergotamine
  • Valproic Acid
  • Magnesium