- American Academy of Neurology (AAN) and American Headache Society (AHS) have updated guidelines on pharmacologic prevention and acute treatment of migraine in children and adolescents.
Why this matters
- New evidence has emerged since guidelines last published in 2004.
- Guidelines recommend discussion of risks and benefits of preventive medication and appropriate acute treatment, shared decision-making.
- Cognitive behavioral therapy plus amitriptyline is more efficacious than headache education plus amitriptyline in reducing migraine attack frequency and migraine-related disability, but amitriptyline may increase risk for suicidal thoughts and behavior.
- Guidelines recommend treating attacks as soon as they begin.
- Ibuprofen, triptans, and combination sumatriptan-naproxen (Treximet) can reduce pain during an attack.
- Although botulinum toxin prevents migraine in adults, it has not shown the same effectiveness in children and adolescents.
- “We reviewed all of the available evidence, and the good news is that there are evidence-based treatments for children and teens that are effective for treating migraine attacks when they occur,” guideline lead author Maryam Oskoui, MD, MSc, of McGill University in Montreal, Canada, and a Fellow of the American Academy of Neurology, commented in a prepared statement. “However, most medications that are designed to prevent recurrent migraine attacks are only as good as placebo when used in children and there is little evidence to guide treatment of related symptoms such as nausea and sensitivity to light. It should be noted that these medications, as well as placebo, were effective in more than 50 percent of the patients.”
- AAN Guideline Development, Dissemination, and Implementation Subcommittee convened multidisciplinary panel of physicians, other health professionals, patients.
- Considered evidence from randomized controlled trials on prevention and acute pharmacologic treatment of migraine in children (individuals
- Prevention guideline based on 15 studies; acute treatment guideline based on 6 studies.
- Excluded studies of medications administered intravenously in emergency department, infusion center.
- Main outcomes: headache frequency; reduction of headache pain, associated symptoms.
- Funding: AAN.
- Lack of evidence in some areas.
- Low quality of evidence for many treatments.