Skip to main content

Advertisement

SpringerLink
Log in

Oral Triptans in Children and Adolescents: An Update

  • Childhood and Adolescent Headache (S Evers, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

This review evaluates the recent progress in clinical trials on oral triptans for acute migraine in children and adolescents. Randomized controlled trials (RCT) on the treatment of migraine in pediatric patients were rare and difficult to design. In particular, high placebo response in many of the trials made it difficult to prove efficacy of triptans. Using a “novel study design” for RCT, a study successfully proved the efficacy of an oral rizatriptan. This trial enrolled patients with unsatisfactory response to nonsteroidal anti-inflammatory or acetaminophen and with migraine lasting longer than 3 h. Rizatriptan was approved by Food and Drug Administration (FDA) (USA) for children and adolescents of 6–17 years. The triptan-NSAID combination drug for pediatric patients also showed efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Evers S. The efficacy of triptans in childhood and adolescence migraine. Curr Pain Headache Rep. 2013;17(7):342. This review suggested that parallel group trials on acute treatment of migraine in children with triptans show a low therapeutic gain because of a high placebo rate.

    Article  PubMed  Google Scholar 

  2. Evers S, Marziniak M, Frese A, Gralow I. Placebo efficacy in childhood and adolescence migraine: an analysis of double-blind and placebo-controlled studies. Cephalalgia. 2009;29(4):436–44.

    Article  CAS  PubMed  Google Scholar 

  3. Lewis DW, Winner P, Wasiewski W. The placebo responder rate in children and adolescents. Headache. 2005;45(3):232–9.

    Article  PubMed  Google Scholar 

  4. Fernandes R, Ferreira JJ, Sampaio C. The placebo response in studies of acute migraine. J Pediatr. 2008;152(4):527. –33, 533.

    Article  PubMed  Google Scholar 

  5. Ho TW, Pearlman E, Lewis D, Hämäläinen M, Connor K, Michelson D, et al. Efficacy and tolerability of rizatriptan in pediatric migraineurs: results from a randomized, double-blind, placebo-controlled trial using a novel adaptive enrichment design. Cephalalgia. 2012;32(10):750–65. This study showed for the first time that oral triptan is significantly more effective than placebo for pediatric patients with migraine. US FDA approved Rizatriptan for the use of children.

    Article  PubMed  Google Scholar 

  6. Derosier FJ, Lewis D, Hershey AD, Winner PK, Pearlman E, Rothner AD, et al. Randomized trial of sumatriptan and naproxen sodium combination in adolescent migraine. Pediatrics. 2012;129(6):e1411–20. The large scale, placebo-controlled evidence for the acute relief of adolescent migraine with oral tablet of sumatriptan and naproxen combination.

    Article  PubMed  Google Scholar 

  7. Fujita M, Sato K, Nishioka H, Sakai F. Oral sumatriptan for migraine in children and adolescents: a randomized, multicenter, placebo-controlled, parallel group study. Cephalalgia. 2014;34(5):365–75.

    Article  PubMed  Google Scholar 

  8. Hämäläinen M. Oral sumatriptan for the acute treatment of migraine in children and adolescents: yet another failed study. Cephalalgia. 2014;34(5):325–6.

    Article  PubMed  Google Scholar 

  9. Sun H, Bastings E, Temeck J, Smith PB, Men A, Tandon V, et al. Migraine therapeutics in adolescents: a systematic analysis and historic perspectives of triptan trials in adolescents. JAMA Pediatr. 2013;167(3):243–9. An important systemic review of trial data submitted to US FDA to identify possible causes for the failure of pediatric trials of triptans for treatment of migraine.

    Article  PubMed  Google Scholar 

  10. Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52(12):1088–97.

    Article  PubMed  Google Scholar 

  11. Arruda MA, Bigal ME. Migraine and migraine subtypes in preadolescent children: association with school performance. Neurology. 2012;79(18):1881–8.

    Article  PubMed  Google Scholar 

  12. Kernick D, Reinhold D, Campbell JL. Impact of headache on young people in a school population. Br J Gen Pract. 2009;59(566):678–81.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Ahonen K, Hämäläinen ML, Rantala H, Hoppu K. Nasal sumatriptan is effective in treatment of migraine attacks in children: a randomized trial. Neurology. 2004;62(6):883–7.

    Article  CAS  PubMed  Google Scholar 

  14. Winner P, Rothner AD, Wooten JD, Webster C, Ames M. Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind, placebo-controlled, acute study. Headache. 2006;46(2):212–22.

    Article  PubMed  Google Scholar 

  15. Eiland LS, Hunt MO. The use of triptans for pediatric migraines. Paediatr Drugs. 2010;12(6):379–89.

    Article  PubMed  Google Scholar 

  16. Vollono C, Vigevano F, Tarantino S, Valeriani M. Triptans other than sumatriptan in child and adolescent migraine: literature review. Expert Rev Neurother. 2011;11(3):395–401.

    Article  CAS  PubMed  Google Scholar 

  17. Linder SL, Mathew NT, Cady RK, Finlayson G, Ishkanian G, Lewis DW. Efficacy and tolerability of almotriptan in adolescents: a randomized, double-blind, placebo-controlled trial. Headache. 2008;48(9):1326–36.

    Article  PubMed  Google Scholar 

  18. Lindkvist J, Airaksinen M, Kaukonen AM, Klaukka T, Hoppu K. Evolution of paediatric off-label use after new significant medicines become available for adults: a study on triptans in Finnish children 1994–2007. Br J Clin Pharmacol. 2011;71(6):929–35.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Ahonen K, Hämäläinen ML, Eerola M, Hoppu K. A randomized trial of rizatriptan in migraine attacks in children. Neurology. 2006;67(7):1135–40.

    Article  CAS  PubMed  Google Scholar 

  20. Fraser IP, Han L, Han TH, Li CC, Hreniuk D, Stoch SA, et al. Pharmacokinetics and tolerability of rizatriptan in pediatric migraineurs in a randomized study. Headache. 2012;52(4):625–35.

    Article  PubMed  Google Scholar 

  21. Hewitt DJ, Pearlman E, Hämäläinen M, Lewis D, Connor KM, Michelson D, et al. Long-term open-label safety study of rizatriptan acute treatment in pediatric migraineurs. Headache. 2013;53(1):104–17.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Fumihiko Sakai declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Saitama International Headache Center, Saitama Neuropsychiatric Institute, 6-11-1 Honmachi-Higashi, Chuo-ku, Saitama-City, Saitama, 338-8577, Japan

    Fumihiko Sakai

Authors
  1. Fumihiko Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fumihiko Sakai.

Additional information

This article is part of the Topical Collection on Childhood and Adolescent Headache

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sakai, F. Oral Triptans in Children and Adolescents: An Update. Curr Pain Headache Rep 19, 8 (2015). https://doi.org/10.1007/s11916-015-0478-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-015-0478-z

Keywords

Search

Navigation