American Academy of Neurology and American Headache Society Release Guidelines for Migraine in Children

The American Academy of Neurology and the American Headache Society have developed guidelines published in Neurology on treating migraine in children. With new medications available, the focus of headache medicine for adults is shifting from treating attack to treating a disease process and reducing disease-related disability. These medications are not yet approved for children, however, and there is much work still to be done to address the disease process in younger people. 

Key points within the new guidelines include: 

• Early treatment—children and teens should treat a migraine attack as soon as they become aware that it is starting 
• Efficacy—the combination of amitriptyline and cognitive behavioral therapy is more effective than amitriptyline alone
• Other medications to use in children and teens include ibuprofen, triptans, and combination sumatriptan/naproxen
• Children and teens with migraine should have a full neurologic examination
• Mood disorders are a frequent comorbidity of migraine that should be treated 
• Lack of physical activity, poor sleep habits, and dehydration may also trigger migraines
• Increased education for children, teens, and their families about migraine is needed

 “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,” said Maryam Oskoui, MD, MSc, McGill University. “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% of the patients.”