Which medications are used for migraine prophylaxis in children?

Updated: Aug 15, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Amy Kao, MD  more...
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Possible medications for migraine prophylaxis include the following:

The FDA has approved topiramate (Topamax) for prevention of migraine headache in adolescents aged 12-17 years. It is the first such approval for this age group. The safety and effectiveness of topiramate in preventing migraine headaches in adolescents were established in a clinical trial of 103 participants. Frequency of migraine decreased by approximately 72% in treated patients compared with 44% in participants receiving placebo. [17, 18]  However, a multicenter, randomized trial of amitriptyline 1 mg/kg/day, topiramate 2 mg/kg/day, and placebo in individuals 8 to 17 years of age with migraine did not demonstrate significant efficacy of either amitriptyline or topiramate over placebo in reducing headache days over a period of 24 weeks. There were also higher rates of adverse events in the amitriptyline and topiramate groups than in the placebo group. [19]

Calcium channel blockers had been used for migraine prophylaxis in children, but results have been inconsistent.

Initially administer drugs at very low dosages and slowly titrate to therapeutic efficacy. This approach lessens adverse effects and results in better long-term patient compliance. Often, several weeks are necessary before therapeutic gains are observed. No consensus exists on the duration of prophylactic medication usage, although most neurologists aim for 3-6 months of good symptom control.

Some patients must be maintained on long-term prophylactic therapy, and others tolerate drug holidays, particularly during summer when migraine attacks are less frequent for many children. Occasionally, prophylactic drugs are effective initially but become ineffective over the long term. Subsequent prophylaxis with the same agent often is not as effective. Withdraw drugs slowly to prevent relapse and withdrawal symptoms.

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