Beyond the Guidelines: A Narrative Review of Treatments on the Horizon for Migraine in Children and Adolescents

Neurology. 2023 Oct 31;101(18):788-797. doi: 10.1212/WNL.0000000000207677. Epub 2023 Aug 21.

Abstract

Migraine is common in children and adolescents and can cause significant disability. There are relatively limited evidence-based treatment options available, especially when compared with treatment of migraine in adults. The Pediatric Research Equity Act requires the study of a new drug or biologic in pediatric populations. As such it is mandatory that the newest migraine treatment options available for adults be evaluated in children and adolescents. It will take years before results from clinical trials in pediatric patients become available. In the meantime, there is eagerness among clinicians to seek out the existing evidence that may help provide clarity on utilization of the newer migraine therapies in children and adolescents because many of the currently available, guideline-recommended treatments do not provide benefit for all patients. In this narrative review, the literature regarding onabotulinumtoxinA, neuromodulatory devices, calcitonin gene-related peptide (CGRP) monoclonal antibodies, 5-hydroxytryptamine (1F) agonists (i.e., ditans), and CGRP small-molecule receptor antagonists (i.e., gepants) for the treatment of migraine in children and adolescents will be summarized.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Antibodies, Monoclonal / therapeutic use
  • Calcitonin Gene-Related Peptide Receptor Antagonists / therapeutic use
  • Calcitonin Gene-Related Peptide* / therapeutic use
  • Child
  • Humans
  • Migraine Disorders* / drug therapy
  • Receptors, Calcitonin Gene-Related Peptide

Substances

  • Calcitonin Gene-Related Peptide
  • Calcitonin Gene-Related Peptide Receptor Antagonists
  • Receptors, Calcitonin Gene-Related Peptide
  • Antibodies, Monoclonal