Anticonvulsant Use for Prophylaxis of the Pediatric Migraine

Lea S. Eiland, PharmD, BCPS; Teri Woo, PhD(c), MS, RN, CPNP; Elizabeth Farrington, PharmD, FCCP, BCPS

Disclosures

J Pediatr Health Care. 2007;21(6):392-395. 

In This Article

Introduction

Migraines are common in the pediatric population. Approximately 3% of children aged 3 to 7 years experience migraines. Prevalence increases to 4% to 11% in children 7 to 11 years of age, and it increases to 8% to 23% in children older than 11 years (Lewis et al., 2004). Boys tend to have an earlier onset of migraines than do girls (7.2 versus 10.9 years, respectively).

Many children with migraines require prophylactic therapy. Nonpharmacologic therapies such as abiding by appropriate sleep patterns, diet, and exercise may be helpful in preventing headaches. If the patient can identify triggers, such as particular foods or caffeine, avoidance is recommended, if possible. Although no clinical studies are available in the pediatric population, children may benefit from nonpharmacologic therapies.

Pharmacotherapy prophylaxis may be utilized to reduce the frequency, duration, or severity of migraines and improve the patient's quality of life (Lewis et al., 2004). Reducing disability and increasing function are important goals of therapy. Prophylactic therapy may be considered when patients have frequent migraines, recurrent episodes that cause impairment despite acute relief, or uncommon migraine conditions such as basilar or hemiplegic migraines (Silberstein, 2000). Patients who are unable to tolerate, overuse, or have contraindications for acute therapies should also be considered for prophylactic therapy (Silberstein). Patient preference in addition to financial issues may warrant therapy as well (Silberstein). Further considerations in children are that the family may be directly or indirectly affected by the child's migraines. Parents may have to leave work to pick up a child with a migraine from school. Parental and child social functioning also may be impaired if the child has frequent migraines.

Several mediations have been touted to prevent migraines in children. However, few actually have clinical trials demonstrating efficacy in this population (Eiland, Jenkins, & Durham, 2007). Amitriptyline and cyproheptadine have been found to be efficacious, but additional studies are warranted. Conflicting data have been reported for propranolol. Recently, more anticonvulsants are being studied for migraine prophylaxis. Valproic acid is an older anticonvulsant that has several trials in children for migraine prophylaxis, yet most of the data are from small populations and adverse effects such as weight gain, somnolence, and alopecia may limit its use (Eiland et al.; Caruso et al 2000, Serdaroglu et al 2002, Freitag et al 2002, Pakalnis et al 2001).

Newer anticonvulsants such as zonisamide and levetiracetam are becoming more popular for migraine use. One anticonvulsant, topiramate, received a Food and Drug Administration indication for migraine prophylaxis in the adult population in 2004. Few clinical studies exist regarding anticonvulsant use for migraine prophylaxis, and currently no anticonvulsants are approved for this indication in children. Gabapentin, topiramate, levetiracetam, and zonisamide use in children are detailed in this review.

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