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


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

In This Article


One small retrospective review evaluated 12 patients (aged 10-17 years) for whom zonisamide was prescribed and who had migraines over a 1-year period (Pakalnis & Kring, 2006). Four of the patients had chronic tension migraines. At least two prior medications for migraine prophylaxis had failed for all patients, and they had from two to 30 headache days per month. Eight patients experienced more than a 50% reduction in headache frequency with zonisamide therapy. Seven of these patients had episodic migraines. Patients with chronic daily headaches did not benefit from taking zonisamide. The duration of follow-up was 3 to 18 months, and the average daily dose of those who responded was 5.8 mg/kg/day. One patient discontinued the medication because of weight loss, and another discontinued it because of behavioral changes. This small evaluation warrants further investigation of zonisamide for migraine prophylaxis in children.

Newer anticonvulsant medications have been evaluated in small trials or retrospective reviews for use in children with migraines. However, none of these agents has been approved for migraine prophylaxis in the pediatric population, and dosing regimens have not been solidified. Of these medications, topiramate has the most data and shows efficacy, but additional trials are needed. Adverse effects should be monitored as well. Larger pediatric trials are required prior to widespread use of levetiracetam. Zonisamide and gabapentin only have one past evaluation each; therefore, additional studies are warranted before recommending these agents for migraine prophylaxis in children.

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