Featured Review: Drugs for the acute treatment of migraine in children and adolescents

Featured Review: Drugs for the acute treatment of migraine in children and adolescents

Cochrane Review provides guidance on what drugs can help kids with migraines

Migraine is a painful and debilitating disorder that is common in children (under 12 years of age) and adolescents (12 to 17 years of age). Common symptoms reported during a migraine attack are headache, nausea, vomiting, and sensitivity to light and sound. Many treatments for migraine are available, of which the most common are paracetamol (also known as acetaminophen), ibuprofen and other anti-inflammatories; and triptans. Not all triptan medications are approved for use in children or adolescents, and approvals vary from country to country.

A team of Cochrane authors based in Canada and the United States worked with the Cochrane Pain, Palliative and Supportive Care Group to assess the effects of pharmacological interventions versus placebo for migraine in children and adolescents to find out which treatments were effective at providing pain freedom two hours after treatment and what the side effects were. The review includes 27 randomized controlled trials of drugs compared to placebo, with a total of 7630 children receiving medication in the studies.

Ibuprofen appears to be effective in treating children with migraine, but the evidence is limited to only two small trials. Paracetamol was not shown to be effective in providing pain relief in children, but only one small study was found. Triptans are a type of medication designed specifically to treat migraine and are often effective at providing greater pain freedom in children and adolescents than a placebo. The triptans examined in children included rizatriptan and sumatriptan, while almotriptan, eletriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan were examined in adolescents. The combination of sumatriptan plus naproxen sodium is also effective at treating adolescents with migraine. Overall, there is a risk that the triptan medications may cause minor unwanted side effects like taste disturbance, nasal symptoms, dizziness, fatigue, low energy, nausea, or vomiting. The studies did not report any serious side effects.

“Parents of children with migraines are looking for both an effective and safe treatment,” said Lawrence Richer, the lead author of the Cochrane Review. “Ibuprofen is readily available and inexpensive, making it an excellent first choice for migraine treatment. Clinicians may consider the triptan class of medications, as well as sumatriptan in combination with naproxen sodium, as suitable options for children and adolescents with migraine, when ibuprofen has failed to provide pain freedom or headache relief.”

Read the full Cochrane Review

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Monday, April 25, 2016