management of childhood migraine

Last edited 10/2022 and last reviewed 03/2023

• assessment of headache and diagnosis of migraine
• initial management should address any underlying concerns of the child and parents/carers
• self-help strategies may help in the prevention of attacks e.g. minimising or avoiding stress, having regular bedtimes and mealtimes and sufficient (not excessive) sleep
• behavioural interventions such as thermal biofeedback and progressive muscle relaxation - these interventions may help but this needs confirmation with appropriate studies
• acute treatment of migraine
  • for the acute treatment of headaches then paracetamol or ibuprofen is usually sufficient, combined with an antiemetics (e.g. domperidone) if vomiting is a problem
  • evidence relating to the use of nasal sumatriptan at the licensed dose to relieve migraine in those aged 12-17 years is weak (1)
• prohylaxis
  • with respect to migraine prophylaxis in children a review states (2):
    • propranolol was found to be possibly effective in reducing migraine frequency by 50% compared with placebo
    • topiramate and cinnarizine (not available in the US or Canada) were possibly associated with reduced frequency of headache compared with placebo

Reference:

1. Drug and Therapeutics Bulletin (2004), 42 (4), 25-8.
2. Hovaguimian A, Roth J. Management of chronic migraine BMJ 2022; 379 :e067670 doi:10.1136/bmj-2021-067670