Use of Serotonin Receptor Agonists in Adolescents with Migraines: Focus on Almotriptan

Marcia L. Buck, Pharm.D., FCCP, FPPAG


Pediatr Pharm. 2009;15(11) 

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Epidemiologic studies have shown an incidence of migraine headaches among adolescents ranging from 2 to 12%.[1] In a recent analysis of adolescent participants in the American Migraine Prevalence and Prevention study, the incidence of migraine meeting the International Classification of Headache Disorders (ICHD-II) criteria was 6.3%.[2] Treatment of migraines in adolescents remains controversial. While serotonin (5-HT1B/1D) receptor agonists, including almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan, have become an important part of treatment in adults, initial studies with these agents in adolescents have produced mixed results. Several studies have failed to demonstrate a significant treatment benefit, which has often been attributed to a high rate of response to placebo. More recent trials however, including two studies using almotriptan, have produced favorable results.[3–7]

Almotriptan was first approved by the Food and Drug Administration (FDA) in 2001 for the treatment of migraines in adults.[8–10] On June 3, 2009, the FDA extended the indication to include treatment of migraines in adolescents between 12 and 17 years of age, making it the first 5-HT1B/1D to be approved for pediatric patients. This issue of Pediatric Pharmacotherapy will describe the clinical trials which supported the FDA approval and review the pharmacology of almotriptan in the pediatric population.


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