Management of childhood migraine

• assessment of headache and diagnosis of migraine
• initial management should address any underlying concerns of the child and parents/carers
• self-help strategies may help in the prevention of attacks e.g. minimising or avoiding stress, having regular bedtimes and mealtimes and sufficient (not excessive) sleep
• behavioural interventions such as thermal biofeedback and progressive muscle relaxation - these interventions may help but this needs confirmation with appropriate studies
• acute treatment of migraine (1)
  • for the acute treatment of headaches then paracetamol or ibuprofen is usually sufficient, combined with an antiemetics (e.g. domperidone) if vomiting is a problem
  • evidence relating to the use of nasal sumatriptan at the licensed dose to relieve migraine in those aged 12-17 years is weak
• prophylaxis
  • with respect to migraine prophylaxis in children a review states (2):
    • propranolol was found to be possibly effective in reducing migraine frequency by 50% compared with placebo
    • topiramate and cinnarizine (not available in the US or Canada) were possibly associated with reduced frequency of headache compared with placebo (3)

Note - one study evaluated the efficacy and safety of zolmitriptan nasal spray (ZNS) in treating migraine headaches in patients aged 6 to 11 years. Though the effect of high-dose ZNS on the primary endpoint of pain-free status at 2 hours was not statistically significant, ZNS was safe and well tolerated in this paediatric population (4)

Reference:

1. Orr SL et al. Paediatric migraine: evidence-based management and future directions. Nat Rev Neurol. 2018 Sep;14(9):515-527
2. Hovaguimian A, Roth J. Management of chronic migraine BMJ 2022; 379 :e067670 doi:10.1136/bmj-2021-067670
3. Surani MK, Yousuf M, Anjum N, Khan S, Hasan G, Hussain S. Topiramate For Migraine Prophylaxis Among Children Aged 5 To 15 Years. J Ayub Med Coll Abbottabad. 2021 Jul-Sep;33(3):480-483
4. Yonker ME, McVige J, Zeitlin L, Visser H. A multicenter, randomized, double-blind, placebo-controlled, crossover trial to evaluate the efficacy and safety of zolmitriptan nasal spray for the acute treatment of migraine in patients aged 6 to 11 years, with an open-label extension. Headache. 2022 Oct;62(9):1207-1217