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Advances in the Acute and Preventive Treatment of Pediatric Migraine

  • Episodic Migraine (S Parikh, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Headaches are common in children and adolescents. Treatments for debilitating migraine are often not FDA approved or lack evidence of efficacy for children. This narrative review looks at the evidence for acute and preventative pharmacologic and non-pharmacologic treatment of pediatric migraine, as well as reviewing any recent or ongoing clinical trials.

Recent Findings

Studies have been published on pharmacological treatments for headache, as well as non-pharmacological treatments. Recent findings in pediatric migraine using onabotulinumtoxinA, calcitonin gene related peptide antagonists, interventional procedures, and devices are reviewed.

Summary

Pharmacologic as well as non-pharmacologic approaches for the prevention and treatment of migraine show safety and efficacy data that is promising. These treatments should be incorporated in a multi-modal approach to the management of pediatric migraine. Continued studies, prospective and randomized, are needed to further assess these newer treatments for migraine in the pediatric setting.

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References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. •• Oskoui M, Pringsheim T, Holler-Managan Y, Potrebic S, Billinghurst L, Gloss D, et al. Practice guideline update summary: acute treatment of migraine in children and adolescents: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):487–99. https://doi.org/10.1212/WNL.0000000000008095. Epub 2019 Aug 14. Erratum in: Neurology. 2020;94(1):50. This is a practice guideline for pediatric migraine supported by the American Headache Society and the American Academy of Neurology.

  2. Hershey AD. Current approaches to the diagnosis and management of paediatric migraine. Lancet Neurol. 2010;9(2):190–204. https://doi.org/10.1016/S1474-4422(09)70303-5.

    Article  CAS  PubMed  Google Scholar 

  3. Fedorowicz Z, Jagannath VA, Carter B. Antiemetics for reducing vomiting relating to acute gastroenteritis in children and adolescents. Cochrane Database Sys Rev. 2011;CD005506.

  4. Winner P, Linder S, Hershey AD. Consistency of response to sumatriptan/naproxen sodium in a randomized placebo-controlled, cross-over study for the acute treatment of migraine in adolescence. Headache. 2015;55:519–28. https://doi.org/10.1111/head.12555.

    Article  PubMed  Google Scholar 

  5. Brandes JL, Kudrow D, Stark SR, et al. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. 2007;297:1443–54. https://doi.org/10.1001/jama.297.13.1443.

  6. Ashina S, Terwindt GM, Steiner TJ, Lee MJ, Porreca F, Tassorelli C, et al. Medication overuse headache. Nat Rev Dis Primers. 2023;9(1):5. https://doi.org/10.1038/s41572-022-00415-0.

    Article  PubMed  Google Scholar 

  7. Burckart GJ, Kim C. The revolution in pediatric drug development and drug use: therapeutic orphans no more. J Pediatr Pharmacol Ther. 2020;25(7):565–73. https://doi.org/10.5863/1551-6776-25.7.565.

    Article  PubMed  PubMed Central  Google Scholar 

  8. •• Oskoui M, Pringsheim T, Billinghurst L, Potrebic S, Gersz EM, Gloss D, et al. Practice guideline update summary: pharmacologic treatment for pediatric migraine prevention: report of the guideline development, dissemination, and implementation subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):500–9. https://doi.org/10.1212/WNL.0000000000008105. Epub 2019 Aug 14. Erratum in: Neurology. 2020;94(1):50. This is a practice guideline for pediatric migraine supported by the American Headache Society and the American Academy of Neurology.

  9. Li BUK. Managing cyclic vomiting syndrome in children: beyond the guidelines. Eur J Pediatr. 2018;177(10):1435–42. https://doi.org/10.1007/s00431-018-3218-7. Epub 2018 Aug 3.

  10. Tekin H, Edem P. Effects and side effects of migraine prophylaxis in children. Pediatr Int. 2022;64(1):e15094. https://doi.org/10.1111/ped.15094.

  11. Banerjee S, Butcher R. Pharmacological interventions for chronic pain in pediatric patients: a review of guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health. 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563527.

  12. Rajdev S, Wassmer E, Agrawal S, et al. Efficacy and tolerability of the use gabapentin for migraine prophylaxis in children. Arch Dis Child. 2012;97:A140.

    Article  Google Scholar 

  13. Powers SW, Coffey CS, Chamberlin LA, et al. CHAMP investigators. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. N Engl J Med 2017;376(2):115–24. https://doi.org/10.1056/NEJMoa1610384.

  14. Powers SW, Hershey AD, Coffey CS, et al. The childhood and adolescent migraine prevention (CHAMP) study: a report on baseline characteristics of participants. Headache. 2016;56:859–70. https://doi.org/10.1111/head.12810.

    Article  PubMed  PubMed Central  Google Scholar 

  15. •• Powers SW, Coffey CS, Chamberlin LA, et al. Prevalence of headache days and disability 3 years after participation in the childhood and adolescent migraine prevention medication trial. JAMA Netw Open. 2021;4(7):e2114712. https://doi.org/10.1001/jamanetworkopen.2021.14712. This is a follow-up survey-based study which was conducted following the conclusion of the CHAMP trial, one of the largest and most important randomized controlled study in the pediatric population.

  16. Shah S, Calderon MD, Wu W, Grant J, Rinehart J. OnabotulinumtoxinA (Botox®) for prophylactic treatment of pediatric migraine: a retrospective longitudinal analysis. J Child Neurol. 2018;33(9):580–6. https://doi.org/10.1177/0883073818776142. Epub 2018 Jun 7.

  17. Kabbouche M, O’Brien H, Hershey AD. OnabotulinumtoxinA in pediatric chronic daily headache. Curr Neurol Neurosci Rep. 2012;12(2):114–7. https://doi.org/10.1007/s11910-012-0251-1.

    Article  CAS  PubMed  Google Scholar 

  18. Winner PK, Kabbouche M, Yonker M, Wangsadipura V, Lum A, Brin MF. A randomized trial to evaluate onabotulinumtoxinA for prevention of headaches in adolescents with chronic migraine. Headache. 2020;60(3):564–75. https://doi.org/10.1111/head.13754. Epub 2020 Feb 9.

  19. Marcelo R, Freund B. The efficacy of botulinum toxin in pediatric chronic migraine: a literature review. J Child Neurol. 2020;35(12):844–51. https://doi.org/10.1177/0883073820931256. Epub 2020 Jun 24.

  20. Goenka A, Yu SG, George MC, Chikkannaiah M, MacDonald S, Stolfi A, et al. Is Botox right for me: when to assess the efficacy of the Botox injection for chronic migraine in pediatric population. Neuropediatrics. 2022. https://doi.org/10.1055/a-1832-9168. Epub 2022 Apr 22.

  21. Shah S, Calderon MD, Crain N, Pham J, Rinehart J. Effectiveness of onabotulinumtoxinA (Botox) in pediatric patients experiencing migraines: a randomized, double-blinded, placebo-controlled crossover study in the pediatric pain population. Reg Anesth Pain Med. 2021;46(1):41–8. https://doi.org/10.1136/rapm-2020-101605. Epub 2020 Oct 26.

  22. Ali SS, Bragin I, Rende E, Mejico L, Werner KE. Further evidence that onabotulinum toxin is a viable treatment option for pediatric chronic migraine patients. Cureus. 2019;11(3):e4343. https://doi.org/10.7759/cureus.4343.

  23. Peck J, Zeien J, Patel M, Cornett EM, Berger AA, Hasoon J et al. Review of interventional therapies for refractory pediatric migraine. Health Psychol Res. 2023;10(5):1–8. https://doi.org/10.52965/001c.67853.

  24. Szperka CL, Gelfand AA, Hershey AD. Patterns of use of peripheral nerve blocks and trigger point injections for pediatric headache; results of a survey of the American Headache Society Pediatric and Adolescent Section. Headache. 2016;1597–607. https://doi.org/10.1111/head.12939.

  25. Gelfand AA, Reider AC, Goadsby PJ. Outcomes of greater occipital nerve injections in pediatric patients with chronic primary headache disorders. Pediatr Neurol. 2014;50:135–9. https://doi.org/10.1016/j.pediatrneurol.2013.09.008. Epub 2013 Nov 20.

  26. Puledda F, Goadsby PJ, Prabhakar P. Treatment of disabling headache with greater nerve injections in a large population of childhood and adolescent patients: a service evaluation. J Headache Pain. 2018;19:5. https://doi.org/10.1186/s10194-018-0835-5.

  27. Goenka A, Chikkannaiah M, Fonseca LD, Kuman G. Peripheral nerve blocks: a tool for inpatient status migrainosus. Pediatr Neurol. 2023;138:81–6. https://doi.org/10.1016/j.pediatrneurol.2022.10.010. Epub 2022 Oct 28.

  28. Hassan R, Gudiwala V, Dawn P, Jeyes L. Greater occipital nerve block as an effective intervention for medically refractory pediatric migraine: a retrospective study. Cureus. 2023;15(2):e34930. https://doi.org/10.7759/cureus.34930.

  29. Mumber HE, Szperka CL. Retrospective study of nerve blocks for the treatment of headaches in children & adolescents. Headache. 2016;56:37.

    Google Scholar 

  30. Renaudon-Smith E, Toolis C, Goadsby P, Prabhakar P. Greater occipital nerve injection (GONI) for chronic headache in children. J Headache Pain. 2010;11(Suppl 1):S76.

  31. Dubrovsky AS, Friedman D, Kocilowicz H. Pediatric post-traumatic headaches and peripheral nerve blocks of the scalp: a case series and patient satisfaction survey. Headache. 2014;54:878–87. https://doi.org/10.1111/head.12334.

    Article  PubMed  Google Scholar 

  32. Seegar TA, Orr S, Bodell L, Lockyer L, Rajapakse T, Barlow KM. Occipital nerve blocks for pediatric posttraumatic headache: a case series: Journal of Child Neurology. 2015;30:1142–6. https://doi.org/10.1177/0883073814553973. Epub 2014 Nov 18.

  33. Zaremski JL, Hurley RW, Herman D, Bauer RM, Ahn AH. Poster 182 occipital neuralgia blockade as a treatment after concussion. A case series PM&R. 2014;6(9):S249. https://doi.org/10.1016/j.pmrj.2014.08.576.

    Article  Google Scholar 

  34. Dance L, Aria D, Schaefer C, Kaye R, Yonker M, Towbin R. Safety and efficacy of sphenopalatine ganglion blockade in children: initial experience. J Vasc Interv Radiol. 2017;282:2(Supplement S8).

  35. Mousa MA, Aria DJ, Mousa AA, Schaefer CM, Temkit MHH, Towbin RB. Sphenopalatine ganglion nerve block for the treatment of migraine headaches in the pediatric population. Pain Physician. 2021;24(1):E111–6.

    PubMed  Google Scholar 

  36. Kouri M, Somaini M, Cardenas VHG, Niburski K, Vigouroux M, Ingelmo P. Transnasal sphenopalatine ganglion block for the preventive treatment of chronic daily headaches in adolescents. Children. 2021;8:606. https://doi.org/10.3390/children8070606.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Turner SB, Szperka CL, Hershey AD, Law EF, Palermo TM, Groenewald CB. Association of headache with school functioning among children and adolescents in the United States. JAMA Pediatr. 2021;175(5):522–4. https://doi.org/10.1001/jamapediatrics.2020.5680.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Farber AJ, Lagman-Bartolome AM, Rajapaske T. Drugs for the acute treatment of migraine in children and adolescents. Paediatri Child Health. 2017;22(8):454–8. https://doi.org/10.1093/pch/pxx170.

    Article  Google Scholar 

  39. Esparham A, Boorigie M, Ablatt S, Connelly M, Bickel J. Improving acute treatment of pediatric primary headache disorders with a novel headache treatment center: retrospective review of preliminary outcomes. J Child Neurol. 2021;36(1):54–9. https://doi.org/10.1177/0883073820952997.

    Article  PubMed  Google Scholar 

  40. Hershey AD, Lin T, Gruper Y, et al. Remote electrical neuromodulation for acute treatment of migraine in adolescents. Headache. 2021;61(2):310–7. https://doi.org/10.1111/head.14042.

    Article  PubMed  Google Scholar 

  41. Irwin SL, Qubty W, Allen E, Patniyot I, Goadsby PJ, Gelfand AA. Transcranial magnetic stimulation for migraine prevention in adolescents: a pilot open-label study. Headache. 2018. https://doi.org/10.1111/head.13284.

    Article  PubMed  Google Scholar 

  42. Grazzi L, Egeo G, Liebler E, Padovan AM, Barbanti P, et al. Non-invasive vagus nerve stimulation (nVNS) as symptomatic treatment of migraine in young patients: a preliminary safety study. Neurol Sci. 2017;38(Suppl 1):197–9. https://doi.org/10.1007/s10072-017-2942-5.

  43. Hargreaves R, Olesen J. Calcitonin gene-related peptide modulators - the history and renaissance of a new migraine drug class. Headache. 2019;59(6):951–70. https://doi.org/10.1111/head.13510. Epub 2019 Apr 25.

  44. •• Szperka CL, VanderPluym J, Orr SL, et al. Recommendations on the use of anti-CGRP monoclonal antibodies in children and adolescents. Headache. 2018;58(10):1658–69. https://doi.org/10.1111/head.13414. This is a very important expert opinion paper on use of some of the newest treatments for pediatric migraine as there is no clinical trial data available in this population.

  45. Evers S. CGRP in childhood and adolescence migraine: (patho)physiological and clinical aspects. Curr Pain Headache Rep. 2022;26(6):475–80. https://doi.org/10.1007/s11916-022-01047-5.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Gibbler RC, Knestrick KE, Reidy BL, Lax DN, Powers SW. Management of chronic migraine in children and adolescents: where are we in 2022? Pediatric Health Med Ther. 2022;13:309–23. https://doi.org/10.2147/PHMT.S334744.

  47. Greene KA, Gentile CP, Szperka CL, et al. Calcitonin gene-related peptide monoclonal antibody use for the preventive treatment of refractory headache disorders in adolescents. Pediatr Neurol. 2021;114:62–7. https://doi.org/10.1016/j.pediatrneurol.2020.09.014.

    Article  PubMed  Google Scholar 

  48. Szkutnik-Fiedler D. Pharmacokinetics, pharmacodynamics and drug-drug interactions of new anti-migraine drugs-lasmiditan, gepants, and calcitonin-gene-related peptide (CGRP) receptor monoclonal antibodies. Pharmaceutics. 2020;12(12):1180. https://doi.org/10.3390/pharmaceutics12121180.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Goadsby PJ, Reuter U, Hallström Y, Broessner G, Bonner JH, Zhang F, et al. A controlled trial of erenumab for episodic migraine. N Engl J Med. 2017;377(22):2123–32. https://doi.org/10.1056/NEJMoa1705848.

    Article  CAS  PubMed  Google Scholar 

  50. Silberstein SD, Dodick DW, Bigal ME, Yeung PP, Goadsby PJ, Blankenbiller T, et al. Fremanezumab for the preventive treatment of chronic migraine. N Engl J Med. 2017;377(22):2113–22. https://doi.org/10.1056/NEJMoa1709038.

    Article  CAS  PubMed  Google Scholar 

  51. Detke HC, Goadsby PJ, Wang S, Friedman DI, Selzler KJ, Aurora SK. Galcanezumab in chronic migraine: the randomized, double-blind, placebo-controlled REGAIN study. Neurology. 2018;91(24):e2211–21. https://doi.org/10.1212/WNL.0000000000006640. Epub 2018 Nov 16.

  52. Ashina M, Saper J, Cady R, Schaeffler BA, Biondi DM, Hirman J, et al. Eptinezumab in episodic migraine: a randomized, double-blind, placebo-controlled study (PROMISE-1). Cephalalgia. 2020;40(3):241–54. https://doi.org/10.1177/0333102420905132. Epub 2020 Feb 19.

  53. Croop R, Goadsby PJ, Stock DA, Conway CM, Forshaw M, Stock EG, et al. Efficacy, safety, and tolerability of rimegepant orally disintegrating tablet for the acute treatment of migraine: a randomised, phase 3, double-blind, placebo-controlled trial. Lancet. 2019;394(10200):737–45. https://doi.org/10.1016/S0140-6736(19)31606-X. Epub 2019 Jul 13.

  54. Croop R, Lipton RB, Kudrow D, Stock DA, Kamen L, Conway CM, et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial. Lancet. 2021;397(10268):51–60. https://doi.org/10.1016/S0140-6736(20)32544-7. Epub 2020 Dec 15.

    Article  CAS  PubMed  Google Scholar 

  55. Ailani J, Lipton RB, Goadsby PJ, Guo H, Miceli R, Severt L, et al. Atogepant for the preventive treatment of migraine. N Engl J Med. 2021;385(8):695–706. https://doi.org/10.1056/NEJMoa2035908.

  56. Vila-Pueyo M. Targeted 5-HT1F therapies for migraine. Neurotherapeutics. 2018;15(2):291–303. https://doi.org/10.1007/s13311-018-0615-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Goadsby PJ, Wietecha LA, Dennehy EB, Kuca B, Case MG, Aurora SK, et al. Phase 3 randomized, placebo-controlled, double-blind study of lasmiditan for acute treatment of migraine. Brain. 2019;142(7):1894–904. https://doi.org/10.1093/brain/awz134.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, USA

    Reena Gogia Rastogi, Eric Vance Hastriter, Rachel L. Evans, Frederick Bassal, Carolyn Hickman, Kavitha T. Karnik, Robert Little & Kara Stuart Lewis

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  1. Reena Gogia Rastogi
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Correspondence to Reena Gogia Rastogi.

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Conflict of Interest

Dr. Reena Rastogi has served on the advisory board for Theranica Bio-electronics Ltd. and received honoraria. Dr. Rastogi is also a sub-investigator for Biohaven Pharmaceuticals, Inc. and Eli Lilly and Company. Dr. Eric Hastriter is a sub-investigator for Biohaven Pharmaceuticals, Inc. and Eli Lilly and Company. Dr. Kavitha Karnik is a sub-investigator for Biohaven Pharmaceuticals, Inc. and Eli Lilly and Company. Dr. Robert Little is a principal investigator for Biohaven Pharmaceuticals, Inc. and Eli Lilly and Company. Dr. Kara Lewis is a sub-investigator for Biohaven Pharmaceuticals, Inc. and Eli Lilly and Company.

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Rastogi, R.G., Hastriter, E.V., Evans, R.L. et al. Advances in the Acute and Preventive Treatment of Pediatric Migraine. Curr Pain Headache Rep 27, 521–529 (2023). https://doi.org/10.1007/s11916-023-01157-8

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