Which medications are used for prophylaxis in the treatment of pediatric migraine headache?

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

Prophylactic agents include the following:

  • Beta-blockers - Propranolol and nadolol

  • Tricyclics - Amitriptyline

  • Antiepileptic drugs - Valproic acid, topiramate, and zonisamide

  • Verapamil

Abortive therapies should be used selectively. If possible, they should be used no more than 4 days in a month, per month, according to Termine et al, but they should be used early on in the course of the attack. [56]

Prophylactic agents can and should be used for daily headache, and they can be considered for over 4 attacks per month for more than 2 months. This has to be addressed clearly with the parents, since it requires a level of commitment.

It must be emphasized that the placebo effect for headache treatment in children is very high, reaching 55% for prophylactic agents and 69% for abortive ones. [57, 58]


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