Which drugs are used in the treatment of acute migraine in children?

Updated: Aug 15, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Amy Kao, MD  more...
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Specific drugs for acute attacks include ergot preparations and triptans. Older vasoconstrictive medications (ergot preparations), such as ergotamine (Cafergot; 1mg ergotamine tartrate with 100mg caffeine), are rarely used today as rescue medications in the pediatric population.

Intravenous (IV) dihydroergotamine (DHE) is an effective abortive agent when used early in an attack and is an option for the older child. Its use in patients younger than 12 years should be questioned.

Serotonin 5-HT-receptor agonists (ie, triptans) work primarily at 2 subtypes of the serotonin receptor, 5-HT1B and 5-HT1D. Triptans are being successfully used with increasing frequency as rescue medications in young migraineurs. Several triptans are approved by the FDA for treatment of acute migraine attacks in adolescents (ie, almotriptan [Axert], zolmitriptan [Zomig Nasal Spray], naproxen/sumatriptan [Treximet]) and in children (ie, rizatriptan [Maxalt]).

Analgesic and abortive therapies are for the treatment of occasional acute headache attacks and associated symptoms. Analgesic and abortive medications should not be used frequently, because this may result in rebound headaches. In general, the earlier in an attack the pain is treated, the less severe the pain becomes. The longer the wait prior to starting therapy, the more difficult the pain is to control. Established migraines are notoriously difficult to treat successfully.

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