Migraine Tip of the Month: What to do for your child’s acute migraine episode
As indicated in the article on pediatric and adolescent migraine included in this issue, many of the medications commonly used by adults for treatment of migraine do not currently possess FDA approval for their use in the (substantial) under-18 migraineur population.
So what is a parent to do? Your son or daughter is in the throes of an acute migraine episode, is miserable with headache, nausea and vomiting and is looking to you, the parent, for help. Soothing words and a damp washcloth only go so far.
There do in fact exist a few prescription medications which are FDA-indicated for acute headache treatment in younger migraineurs. The combination of oral sumatriptan and naproxen sodium (initially released as Treximet) is approved for the treatment of acute migraine headache for children age 12 or older. Two other oral triptans also have FDA approval for use in the younger migraine population. Rizatriptan (initially released as Maxalt) 5 or 10 mg is indicated for children age 6 and older, with the lower dose recommended for children weighing less than 40 kg (88 lbs), and almotriptan (initially released as Axert) 6.25 or 12.5 mg is indicated for those age 12 and older.
Sumatriptan nasal spray 5 or 20 mg and zolmitriptan (initially released as Zomig) nasal spray 2.5 and 5 mg have been approved for use in children age 12 and older. This delivery system obviously has an advantage if the migraine episode involves nausea and vomiting. In addition, child and adolescent acute migraine episodes often develop and build rapidly, and intranasal administration may speed the onset of the medication’s therapeutic action.
“Non-specific” medications recommended for acute migraine headache in kids include acetaminophen 10-15 mg/kg, ibuprofen 10 mg/kg and naproxen sodium 10-20 mg/kg/day. “Migraine-specific” oral medications that are often prescribed for acute treatment but currently lack specific FDA approval for use in children include eletriptan (initially released as Relpax) 20-40 mg, sumatriptan (initially released as Imitrex) 25-100 mg and zolmitriptan 2.5-5 mg).
In January of this year the FDA approved an interesting non-pharmacologic therapy for acute migraine headache in kids age 12 and above: the Nerivio wireless remote electrical neuromodulation device. The Nerivio device was featured as the “Migraine Treatment of the Month” in our Winter 2019/20 issue.
General measures to take in treating your child’s acute migraine episode include rest, removing sources of sensory stimulation (light, noise) and encouraging oral fluid intake. If nausea is making the last difficult, have an anti-nausea medication on hand, and make sure you have both oral and rectal/suppository formulations. Commonly used options include promethazine, prochlorperazine and ondansetron.