What is the efficacy of triptans for the treatment of pediatric headache?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Answer

In children aged 12-17 years, controlled clinical trials with oral sumatriptan failed to show efficacy. This is probably due to high placebo effect observed in pediatric migraine trials. This means that children seem to respond well to placebo, therefore obscuring the response to active medication. Pediatric and adolescent studies indicate efficacy with the nasal spray form of this medication. [46]

Subcutaneous sumatriptan has also been effective, although the manufacturer does not recommend the use of it in patients who are younger than 18 years. In children, the trial subcutaneous dose is 0.1 mg/kg/dose. Current autoinjection sumatriptan is available in 6 mg and 4 mg unit doses.

Several triptans are approved by the US Food and Drug Administration (FDA) to be used as abortive therapy in the treatment of pediatric migraine. A study by Linder et al provided evidence that almotriptan (Axert) is effective and well tolerated in adolescents with migraines; the drug gained FDA approval for this indication shortly after the study. [47] Other triptans that are approved for acute treatment of pediatric migraine include rizatriptan (Maxalt) in children aged 6-17 years [48, 49] and zolmitriptan (Zomig Nasal Spray). In the Spring of 2015 the FDA approved a combination of naproxen sodium and sumatriptan (Treximet) for the acute treatment of migraine with or without aura in pediatric patients 12 years of age and older. [50]

Clinicians usually use almotriptan, rizatriptan for pediatric migraine, and other triptans off-label in their daily clinical practice, even if they are not indicated by the FDA for children. These include, in no specific order, naratriptan (Amerge), eletriptan (Relpax), and frovatriptan (Frova).

Clinical trials of some of these medications in children are currently under way. For years in the author's practice, when children and adolescents have not responded to nonsteroidal anti-inflammatory drugs (NSAIDs) or other over-the-count (OTC) analgesics, he has treated them with triptans, with good results.


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