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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medications

The drug treatments of migraine headache and associated symptoms can be divided into

• analgesic (pain relieving),
  
  
• abortive (pain ending), and
  
  
• prophylactic (pain preventing) therapies.

Analgesic and abortive therapy

Analgesic and abortive therapies are for the treatment of occasional severe headache attacks and related symptoms. Analgesic and abortive medications should not be used frequently (that is, more than two times per week) because they may cause rebound headaches when children stop taking them. In general, the earlier in an attack the pain is treated, the less severe the pain becomes. The longer the wait before starting therapy, the more difficult the pain is to control. Established migraines are notoriously difficult to treat successfully.

Digestion temporarily slows or stops during migraine attacks, delaying absorption of oral medications. In addition to drug therapy approaches, other approaches to reducing the severity of many childhood migraines include avoiding sensory stimulation (for example, bright lights, intense odors), applying ice packs, and resting in a quiet, dark room.

Preventive medications

Preventive medications are taken on a daily basis over a long period of time to reduce the frequency or severity of headaches and associated symptoms. None of the preventive medications are 100% effective in preventing all attacks. A good response to preventive medications is a 50% reduction in the frequency or severity of attacks. Children should not be given these drugs unless they have frequent (more than two per week), prolonged, and disabling migraine attacks that do not respond to other treatments. Often, several weeks are necessary before improvement is observed.

Some child migraineurs must be kept on long-term preventive therapy, while others tolerate drug "holidays," particularly during summer, when migraines are less frequent for many children. Occasionally, these drugs lose their effectiveness after initially helping the child. Using the same drug later is often not very effective. Different drugs work better for different people; therefore, several may have to be tried before finding the best drug for a particular child. Preventive drugs should be withdrawn slowly to avoid relapse and withdrawal symptoms.

Abortive drugs

The following drugs are used to treat quickly stop migraine headaches in mid attack. They have little preventive value:

The first group is the "triptans," which specifically target serotonin. They are all chemically very similar, and their action is similar.

• sumatriptan (Imitrex, Imigran)
  
  
• zolmitriptan (Zomig, Zomig-ZMT)
  
  
• naratriptan (Amerge, Naramig)
  
  
• rizatriptan (Maxalt, Maxalt-MLT)
  
  
• almotriptan (Axert)
  
  
• frovatriptan (Frova)
  
  
• eletriptan (Relpax)

The following drugs are also specific and affect serotonin, but they affect other brain chemicals as well. Occasionally, one of these drugs works when a triptan does not.

• ergotamine tartrate (Cafergot)
  
  
• dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
  
  
• acetaminophen-isometheptene-dichloralphenazone (Midrin)

Preventive drugs

The following daily drugs have preventive value and are helpful to those who have more than two migraine headaches per week:

• Medications used to treat high blood pressure: Beta-blockers [propranolol (Inderal), calcium channel blockers (verapamil (Covera)]
  
  
• Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor)
  
  
• Antiseizure medications: gabapentin (Neurontin), valproic acid (Depakote), topiramate (Topamax)

Children with status migrainosus

Children with status migrainosus (a severe form of migraine headache in which the attack is continuous over 72 hours) can be treated in an emergency department or a doctor's office with intravenous or intramuscular medications.