Migraine is a common yet often debilitating issue among children and teenagers, studies estimating that about 11 percent of young people suffer from this condition. As kids approach adolescence, migraines become more frequent, particularly among girls.

Migraines in young people do not just bring pain; they impact daily life, school performance, and even social activities. Studies also suggest that having migraines in youth can increase the risk of developing mental health challenges like anxiety and depression later in life.

The International Headache Society has developed specific guidelines, the International Classification of Headache Disorders, for identifying migraines based on factors like pain location, duration, and symptoms such as nausea or light sensitivity. But, although diagnosing migraines in children is usually straightforward, finding effective treatments is more complex.

The study
The researchers did a comprehensive network meta-analysis to evaluate the efficacy and safety associated with pharmacological treatments for pediatric migraine. With a focus on randomized clinical trials, the initial search for relevant papers yielded no less than 9162.

Five investigators independently extracted the study data into a spreadsheet. Study-level estimates, the scientific quality of the studies, were calculated, and the primary and secondary outcomes.

So, how do we treat our children with migraine?
Treatment generally falls into two types: one for immediate relief of pain and another for long-term prevention of future attacks. Standard pain relievers like acetaminophen and ibuprofen are often used for young children, while triptans—a class of drugs designed to treat migraines—are more common in teens. However, only one triptan, rizatriptan, is fully approved for use in children as young as six, with others only recommended for teens.

Preventing migraines is a greater challenge. While there are medications to prevent attacks in adults, options for younger patients are limited. One of the few approved drugs, topiramate, has shown only modest benefits in children and adolescents, making it clear that more studies are needed to develop effective preventive strategies for young people.

To address this gap, a recent meta-analysis examined a range of treatments to see which options might offer both effective relief and few side effects for pediatric migraine sufferers.

The study analyzed clinical trials involving thousands of children and teens to compare the effectiveness of several preventive medications, including pregabalin, flunarizine, and riboflavin. Some drugs like pregabalin and topiramate reduced the frequency of migraines by up to 62 percent when compared with placebos. Researchers also explored combinations, such as pregabalin with vitamin D and riboflavin, which seemed to enhance effectiveness.

However, none of the drugs studied made a notable difference in quality of life or in reducing the duration of migraine episodes.

In conclusion, this comprehensive overview sheds light on the pharmacological management of pediatric migraine, revealing that treatments like pregabalin, topiramate (with and without vitamin D3 supplementation), levetiracetam, flunarizine, riboflavin, amitriptyline, and cinnarizine may reduce migraine frequency in pediatric patients. The study underscores the potential benefits of combination therapies, particularly those involving vitamin supplementation.

However, these treatments did not improve the quality of life or reduce the duration of migraine attacks, highlighting the need for further research to develop more comprehensive therapeutic strategies.

About the scientific paper:

First author: Omid Kohandel Gargari, MD, Iran
Published: JAMA October 2024.
Link to paper: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2824677