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When to Consider Prophylactic Antimigraine Therapy in Children with Migraine

  • Headache (JR Couch, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

Headache is not an uncommon complaint in children, and recognition of migraine is increasing in children and adolescents. Treatment options consist of abortive and preventive medications; however, when to start the preventive treatment is not clear in the pediatric population. This article reviews current guidelines and practices to provide a better clinical approach in the management of migraines in children and adolescents.

Recent findings

Currently, the only FDA-approved medical treatment option for preventive therapy in chronic migraine in adolescents is topiramate. However, the Childhood and Adolescent Migraine Prevention Study (CHAMP) did not endorse superiority of topiramate or amitriptyline over placebo.

Summary

At this time, there is no clear consensus on when to start preventive therapy in children and adolescents with migraines. The decision is multifactorial and should be initiated after a thorough discussion with the patient and caregiver(s) about related risks and benefits of treatment. Education regarding various modalities of treatment and ensuring compliance is essential to treatment success.

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References and Recommended Reading

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

  1. Headache Classification Committee of the International Headache Society. (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.

    Article  Google Scholar 

  2. Olesen J, Steiner T, Bousser MG, Diener HC, Dodick D, First MB, et al. Proposals for new standardized general diagnostic criteria for the secondary headaches. Cephalalgia. 2009;29(12):1331–6.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  4. Lipton RB, Manack A, Ricci JA, Chee E, Turkel CC, Winner P. Prevalence and burden of chronic migraine in adolescents: results of the chronic daily headache in adolescents study (C-dAS). Headache. 2011;51(5):693–706.

    Article  Google Scholar 

  5. Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30(9):1065–72.

    Article  CAS  Google Scholar 

  6. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001;41(7):646–57.

    Article  CAS  Google Scholar 

  7. Su M, Yu S. Chronic migraine: a process of dysmodulation and sensitization. Mol Pain. 2018;14:1744806918767697.

    PubMed  PubMed Central  Google Scholar 

  8. O’Brien HL, Kabbouche MA, Hershey AD. Treating pediatric migraine: an expert opinion. Expert Opin Pharmacother. 2012;13(7):959–66.

    Article  Google Scholar 

  9. Winner P. Pediatric headache. Curr Opin Neurol. 2008;21(3):316–22.

    Article  Google Scholar 

  10. Stewart WF, Lipton RB, Dowson AJ, Sawyer J. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56(6 Suppl 1):S20–8.

    Article  CAS  Google Scholar 

  11. Ware JE Jr. SF-36 health survey update. Spine (Phila Pa 1976). 2000;25(24):3130–9.

    Article  Google Scholar 

  12. Silberstein SD, Winner PK, Chmiel JJ. Migraine preventive medication reduces resource utilization. Headache. 2003;43(3):171–8.

    Article  Google Scholar 

  13. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343–9.

    Article  CAS  Google Scholar 

  14. Kashikar-Zuck S, Zafar M, Barnett KA, Aylward BS, Strotman D, Slater SK, et al. Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia. Clin J Pain. 2013;29(12):1066–72.

    Article  Google Scholar 

  15. Connelly M, Rapoff MA. Assessing health-related quality of life in children with recurrent headache: reliability and validity of the PedsQLTM 4.0 in a pediatric headache sample. J Pediatr Psychol. 2006;31(7):698–702.

    Article  Google Scholar 

  16. PedMIDAS Tool Cincinnati Children's Hospital Medical Center. Lipton and Stewart. Children's Hospital Medical Center, 2001

  17. Headache Classification Committee of the International Headache S. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.

    Article  Google Scholar 

  18. Powers SW, Mitchell MJ, Byars KC, Bentti AL, LeCates SL, Hershey AD. A pilot study of one-session biofeedback training in pediatric headache. Neurology. 2001;56(1):133.

    Article  CAS  Google Scholar 

  19. Labbe EE. Treatment of childhood migraine with autogenic training and skin temperature biofeedback: a component analysis. Headache. 1995;35(1):10–3.

    Article  CAS  Google Scholar 

  20. Werder DS, Sargent JD. A study of childhood headache using biofeedback as a treatment alternative. Headache. 1984;24(3):122–6.

    Article  CAS  Google Scholar 

  21. FDA approves Topamax for migraine prevention in adolescents. J Pain Palliat Care Pharmacother. 2014;28(2):191.

    Google Scholar 

  22. Abstracts of the 47th Annual Congress of the Canadian Neurological Sciences Federation, June 5–8, 2012, Ottawa, Ontario, Canada. Can J Neurol Sci. 2012;39(3 Suppl 3):S1–54.

  23. • Powers SW, Coffey CS, Chamberlin LA, Ecklund DJ, Klingner EA, Yankey JW, et al. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. N Engl J Med. 2017;376(2):115–24 Trial demonstrating no significant differences in reduction in headache frequency or headache-related disability in childhood and adolescent migraine with amitryptiline, topiramate, or placebo over a period of 24 weeks.

    Article  CAS  Google Scholar 

  24. •• Fallah R, Fazelishoroki F, Sekhavat LA. Randomized clinical trial comparing the efficacy of melatonin and amitriptyline in migraine prophylaxis of children. Iran J Child Neurol. 2018;12(1):47–54 Recent randomized controlled trial comparing amitriptiline and melatonin for migraine prophylaxis and considered amitryptiline to be safer but associated with more adverse events.

    PubMed  PubMed Central  Google Scholar 

  25. Kacperski J, Hershey AD. Preventive drugs in childhood and adolescent migraine. Curr Pain Headache Rep. 2014;18(6):422.

    Article  Google Scholar 

  26. Bonfert M, Straube A, Schroeder AS, Reilich P, Ebinger F, Heinen F. Primary headache in children and adolescents: update on pharmacotherapy of migraine and tension-type headache. Neuropediatrics. 2013;44(1):3–19.

    Article  CAS  Google Scholar 

  27. Lipton RB, Silberstein SD, Saper JR, Bigal ME, Goadsby PJ. Why headache treatment fails. Neurology. 2003;60(7):1064–70.

    Article  CAS  Google Scholar 

  28. Pakalnis A, Kring D. Zonisamide prophylaxis in refractory pediatric headache. Headache. 2006;46(5):804–7.

    Article  Google Scholar 

  29. Fan PC, Kuo PH, Chang SH, Lee WT, Wu RM, Chiou LC. Plasma calcitonin gene-related peptide in diagnosing and predicting paediatric migraine. Cephalalgia. 2009;29(8):883–90.

    Article  Google Scholar 

  30. Ahmed K, Oas KH, Mack KJ, Garza I. Experience with botulinum toxin type A in medically intractable pediatric chronic daily headache. Pediatr Neurol. 2010;43(5):316–9.

    Article  Google Scholar 

  31. Cleophas TJ. Clinical trials with large numbers of variables: important advantages of canonical analysis. Am J Ther. 2016;23(3):e825–36.

    Article  Google Scholar 

  32. Pandina GJ, Ness S, Polverejan E, Yuen E, Eerdekens M, Bilder RM, et al. Cognitive effects of topiramate in migraine patients aged 12 through 17 years. Pediatr Neurol. 2010;42(3):187–95.

    Article  Google Scholar 

  33. Sakulchit T, Meckler GD, Goldman RD. Topiramate for pediatric migraine prevention. Can Fam Physician. 2017;63(7):529–31.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Texas Tech Health Science Center, Paul Foster School of Medicine, 4800 Alberta Ave, El Paso, TX, USA

    Mushtaq H. Qureshi MD

  2. Department of Neurology, Emory Brain Health Center, Atlanta, GA, USA

    Gregory J. Esper MD, MBA & Ferhad F. Bashir MD

Authors
  1. Mushtaq H. Qureshi MD
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  2. Gregory J. Esper MD, MBA
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  3. Ferhad F. Bashir MD
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Corresponding author

Correspondence to Mushtaq H. Qureshi MD.

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Conflict of Interest

Mushtaq Qureshi and Ferhad Bashir each declare no potential conflicts of interest. Gregory Esper reports other from NeuroOne, Inc., outside the submitted work.

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

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Qureshi, M.H., Esper, G.J. & Bashir, F.F. When to Consider Prophylactic Antimigraine Therapy in Children with Migraine. Curr Treat Options Neurol 21, 15 (2019). https://doi.org/10.1007/s11940-019-0560-7

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  • DOI: https://doi.org/10.1007/s11940-019-0560-7

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