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.
"The happy news is that the outcomes for behavioral migraine treatments are really quite strong," Penzien tells WebMD. "They not only treat pain but have the added bonus of helping with the family and school disruption that goes with headache."
The key to behavioral treatments for migraine is a healthy lifestyle, Lewis says.
"Teens, for example, often have chaotic sleep patterns. They tend to skip breakfast, get too much caffeine either in sodas or lattes, and often experience a lot of stressors in their lives," he says. "So we make sure they eat right and get exercise -- that is critical. I mandate 20-30 minutes of exercise every single day. We do a lifestyle change, keep a migraine calendar, and then we can see whether further treatment is needed."
Lewis and Penzien agree that no single approach works for every child. But many approaches that work for adults can easily be adapted for children.
"The same treatments for adults that we call behavioral -- relaxation, biofeedback, stress management, cognitive-behavioral psychotherapy -- with special adaptations can be made for children," Penzien says. "The self-regulation training therapies - the relaxation, the biofeedback -- tend to work much better for kids. They take to it like a duck to water."