Kids' Migraines: Over-the-Counter Drugs Best
New Pediatric Migraine Guidelines Wary of Newer Drugs
Dec. 28, 2004 -- New drug-therapy guidelines for kids' migraines stress tried-and-true medicines -- and find newer drugs unproven.
The guidelines say ibuprofen (Advil and Motrin, for example) and acetaminophen (Tylenol) are safe and effective for acute migraine pain in kids aged 6 years and older. Teens may also benefit from Imitrex nasal spray.
What about newer drugs that work for adult migraines? There's no proof they work in kids, the guidelines say. Similarly, the guidelines offer no easy solution to preventing migraines. Only one drug is proven effective. That drug, Sibelium, is not available in the U.S.
What gives? The problem is that pediatric clinical trials of these drugs are few and far between. And those that have been done often suffer from poor design, says Donald Lewis, MD, lead author of the guidelines. Lewis is professor of pediatrics and neurology at Eastern Virginia Medical School and a child neurologist at Children's Hospital of the King's Daughters in Norfolk, Va.
"This is one of those unfortunate areas where a very common problem has been understudied," Lewis tells WebMD. "There is a lot of denial, among families and among clinicians, that children do get migraines. We need more clinical trials to see how these medicines work in children. ... One of the themes here is that initial trials have failed. More intense and innovative research needs to be done."
The guidelines, endorsed by the American Academy of Pediatrics and the American Headache Society, come from the American Academy of Neurology and are based on a review of published studies. They appear in the Dec. 28 issue of Neurology.
Good News: Nondrug Treatment Works
Not all kids need drugs for successful migraine treatment and prevention, Lewis stresses.
"The treatment for many problems in children is not just drugs. It is often a lifestyle change," Lewis says. "Biobehavioral migraine treatment is a whole-package approach to managing these children. For every patient, treatment has to be individually tailored. We may not commit a child to daily medication right off the bat."
Behavioral treatments work for adults. And they work even better for kids, says psychiatry professor Donald B. Penzien, PhD, director of the University of Mississippi's head pain center.