Materiały źródłowe

• #1 The Treatment of Migraine Headaches in Children and Adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3462052/

  Effective management of migraine headache in children and adolescents requires a balanced approach with an individually tailored regimen targeted to treat an acute attack at its onset, blended with bio-behavioral measures, and, in about 1/3 of patients, daily preventive medicines. […] All patients will benefit from some basic bio-behavioral suggestions such as regular sleep, exercise, and eating schedule, moderation of caffeine, and identification of triggers. […] A subset of migraineurs will have sufficient headache burden to necessitate use of daily preventative medications. […] To achieve these goals, a balanced, flexible and individually tailored treatment regimen must include bio-behavioral strategies and non-pharmacological methods as well as pharmacological measures. […] The basic recommendations which should be provided to all migraineurs include regulation of sleep, institution of a regular exercise program, moderation or elimination of caffeine, and encouragement to keep adequately hydrated.

• #1 Migraine in Children and Adolescents

  https://practicalneurology.com/articles/2023-may-june/migraine-in-children-and-adolescents

  The general principles of migraine prophylaxis are to reduce attack frequency, severity, and duration; improve responsiveness to treatment of acute attacks; improve function; and reduce disability.16 Using these guidelines can help provide a rationale for the institution of prophylaxis, such as in recurring migraines that cause daily disability, despite acute treatment; when frequency of attacks is greater than 4 per month; or a person has a contraindication to or has failed or overused acute therapies, has had adverse effects with acute therapies, or has an uncommon migraine condition, such as hemiplegic migraine.16 […] Pediatric and adolescent patients should have water intake goals, engage in some form of exercise 3 days per week,18 and receive sleep guidelines tailored to their developmental stage.4

• #1 Migraines in Children: Recommendations for Acute and Preventive Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p569.html

  No medications have been shown to be more effective than placebo for preventing migraine in children and adolescents. […] CBT appears to be effective for reducing migraine frequency in children and adolescents. […] Prevention should be considered if headaches occur frequently, are severe, and result in significant disability. […] Counseling and education are important for patients and their families, especially because of the lack of useful pharmacologic therapy. […] Behavioral factors that influence the frequency of headaches in adolescents are obesity and overweight, caffeine and alcohol use, lack of physical activity, poor sleeping habits, and tobacco exposure. […] Losing weight has been shown to reduce headaches in overweight children. […] Consider trigger avoidance for children and adolescents who have frequent headaches or migraine-related disabilities.

• #1 How to treat children with migraine in primary care – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – Arrow

  https://migrainetrust.org/migraine-in-children-and-young-people/how-you-can-help-a-young-patient-with-migraine/how-to-treat-children-with-migraine-in-primary-care/

  There are numerous migraine treatment options available for adults, which include acute and preventive medications, medical devices, supplements, and acupuncture. While some of these treatment options are currently unavailable for children, particularly some of the newer medication that has yet to be trialled on children, there is still a range of ways that you can treat children with migraine. […] Self-management is also an important part of living with migraine. We recommend that people with migraine use a migraine diary to help them understand the patterns of their migraine and identify possible migraine attack triggers. This can help them avoid or reduce certain triggers such as dehydration or stress. […] It is therefore important to give children, their parents and carers, information on managing stress but also pacing themselves. It is not about telling children that they can’t do certain things, but helping them understand that pacing their activity might help them manage their migraine better.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  Migraine treatment […] General measures — Although many triggers have been suspected to induce, promote, or sustain an attack of migraine, the specific factors that trigger attacks can differ from one person to another and may be inconsistent between attacks. Mobile phone apps can closely track potential triggers to help identify specific triggers for individual patients. A partial list of potential triggers appears in the table (table 1). Children who have frequent or severe attacks should keep a record of their headaches in a headache diary. This can help to determine if a specific pattern or exposure can be avoided to prevent future headaches. […] There are two types of migraine treatments: acute and preventive. Acute treatments are administered to treat the current migraine attack symptoms (eg, pain, nausea, etc), while preventive treatments are given to prevent attacks of migraine from developing.

• #1 Headaches in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/symptoms-causes/syc-20352099

  Avoid headache triggers. Avoid any food or drinks, such as those containing caffeine, that seem to trigger headaches. Your headache diary can help you determine what prompts your child’s headaches, so you know what to avoid. […] Follow your doctor’s plan. Your doctor may recommend preventive medication if the headaches are severe, occur daily and interfere with your child’s normal lifestyle. Certain medications taken at regular intervals such as certain antidepressants, anti-seizure medications or beta blockers may reduce the frequency and severity of headaches.

• #1 Chronic Headaches in Children

  https://mydoctor.kaiserpermanente.org/mas/structured-content/Condition_Chronic_Headaches_in_Children_-_Pediatric_Neuro.xml?co=/regions/mas

  To help prevent chronic or rebound headaches, you can try these strategies. […] Be your child’s detective. Keep a headache diary to discover what triggers your child’s headaches. You’ll be able to see whether there’s a pattern or cycle. Help your child avoid their triggers. […] Take a step back. The only way to stop rebound headaches is to avoid overuse of pain medicines. Help your child make healthier choices about food, sleep, and stress to reduce or prevent headaches. […] Avoid specific foods. As best you can, limit processed (“fast” or “junk”) foods that contain high levels of sugar, salt, and artificial ingredients. It may also help to avoid foods with nitrates, nitrites, and monosodium glutamate (MSG).

• #1

  https://www.healthychildren.org/English/health-issues/conditions/treatments/Pages/Natural-Therapies-for-Children-with-Chronic-Headaches.aspx

  One in 3 young people ages 10 to 17 who regularly experience headaches are turning to some type of „natural” or integrative medical therapy, which consists of the use of conventional, complementary and alternative medicine (CAM) for prevention and treatment. […] If you are exploring natural therapies to treat your child’s headaches, it is important for you to educate yourself fully on the pros and cons of each approach and discuss the options thoroughly with your child’s pediatrician before you take any action. […] Massage therapy may be helpful for a child with chronic daily headaches and includes a variety of techniques in which practitioners manipulate the soft tissues of the body. […] Acupuncture may also benefit a child with headaches. […] Biofeedback is one of the treatments researched most extensively for migraines.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  Programs that help to alleviate stress may also be helpful for children with chronic TTH (headaches >15 days per month for at least three months). This may include psychologic counseling, relaxation therapy, biofeedback, and CBT. Biofeedback teaches the child to voluntarily control certain body functions, including heart rate, blood pressure, and muscle tension. CBT is more extensive but may have longer term benefits. […] If the headaches do not improve with rescue medication, the health care provider may recommend that the child be evaluated by a specialist (eg, neurologist). The specialist may recommend a medication, such as a tricyclic antidepressant (TCA). The most commonly prescribed TCA for headaches is amitriptyline (sample brand name: Elavil). The dose of TCAs used for treating chronic pain is typically lower than that used for treating depression. It is believed that TCAs reduce pain perception when used in low doses, although the mechanism of their benefit is unknown.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Migraine-Headaches-in-Children.aspx

  Preventive medications. There are some medications that when taken daily can help reduce the severity and/or frequency of migraines. These tend to be off-label, meaning they are not approved by the U.S. Food and Drug Administration for migraines. Their risks and benefits should be discussed with your doctor. Options include: […] Cardiovascular drugs: propranolol […] […] Antidepressants drugs: amitriptyline […] […] Anti-seizure drugs: topiramate […] […] Antihistamines: cyproheptadine […] Children who suffer from migraines are absent from school twice as often as other students. Talk with your child’s teachers and school nurse about ways to help avoid missed class time. A letter from the doctor explaining your child’s diagnosis and the medications they take when they feel a migraine coming on can help the conversation. Helpful accommodations may include making sure your child has ready access to water and snacks, for example.

• #1 Addressing Headaches in Children: Prevention and Treatment Strategies

  https://support.doctorpodcasting.com/client/lebonheur/item/46749-addressing-headaches-in-children-prevention-and-treatment-strategies

  So we have a comprehensive headache center here at Le Bonheur Children’s Hospital. And we actually practice our goal, which is as a team, we just don’t want to treat kids with medications, but actually educate them about the headache disorder. I think that is the most important thing, what we can do for them, so that they feel empowered to get help promptly. […] I always encourage parents who have children with migraine or any other headache disorder to have a chat at school. Because the more we educate schools, the more they would be empathetic and understanding, and we could reduce the impact on school attendance badly. So whenever we see any patient, we actually give a patient something like a school letter, which states that whenever they feel like they’re going to have their migraine attack or the headaches is coming up, they could sit in a quiet dark place, they can get their acute abortive medication, which has been prescribed to them and rest for a while. And that is very important because, most importantly, I think like rest and drinking water at that time and getting like medication on time is really important when you are in school so that you can feel more functional you can function as a normal kid. So we also give resources to parents to help them advocate for their children.

• #1 The Treatment of Migraine Headaches in Children and Adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3462052/

  A diverse group of medications are used to prevent migraine attacks. Their use, however, should be limited to those patients whose headaches occur with sufficient frequency (at least 3 headaches per month), severity, and functional disability to warrant a daily treatment program. […] Currently, the typical first-line choices for migraine prophylaxis are cyproheptadine, non-steroidal anti-inflammatory agents (NSAIDs), antiepileptic medications (topiramate and disodium valproate) and amitryptyline. […] The antihistamine cyproheptadine has anti-serotonergic and calcium channel blocker properties. […] Antiepileptic drugs such as topiramate, disodium valproate, levetiracetam, and gabapentin may have expanding roles for pediatric migraine in the future. […] About 1/3 of patients will have migraine headaches with sufficient frequency and severity to justify the temporary use of preventive medicines.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  Preventive treatments — Evidence regarding the safety and efficacy of preventive treatments for migraine is limited. Several medications have been tested in clinical trials, but none have shown consistent benefit over placebo (a sugar pill). Nevertheless, some experts have found the following medications to be helpful: […] ● Cyproheptadine (brand name: Periactin) is an antihistamine that is used for prevention of attacks of migraine. It may be recommended for prevention in young children. Side effects can include sleepiness and increased appetite. Increased appetite may cause substantial unwanted weight gain, which may limit the use of cyproheptadine in children older than 10 years. […] ● Propranolol (sample brand name: Inderal) is a blood pressure medication that is frequently prescribed to prevent attacks of migraine in adults. It is sometimes recommended for prevention of attacks of migraine in children. The child’s heart rate and blood pressure should be monitored during treatment, as both may be lowered by the medication. Propranolol should not be used by children with asthma or type 1 diabetes and may make teenagers feel depressed.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  ● Although scientific studies have not validated the effectiveness of herb, mineral, or vitamin supplements, some patients have found supplemental magnesium, riboflavin, or coenzyme Q10 to be helpful as a preventive treatment. If taken in moderate doses, these agents are unlikely to be harmful. Nonetheless, caregivers should talk to their child’s health care provider before using this type of treatment. […] ● A large study regarding prevention of the attacks of migraine in children and adolescents has demonstrated that amitriptyline, topiramate, and placebo are all effective in preventing attacks, but none is superior. […] ● CBT has been demonstrated to be effective in preventing frequent attacks in children and adolescents with chronic migraine. This is typically a four-to-six week course that includes biofeedback, assisted relaxation training, adherence management, reduction of negative thoughts, and promotion of positive health activities.

• #1 Migraines in Children: Recommendations for Acute and Preventive Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p569.html

  Preventive pharmacologic medications were not superior to placebo in most randomized controlled trials, yet the placebo response is high. […] Although amitriptyline combined with CBT has been shown to be more effective than amitriptyline without CBT, amitriptyline has a boxed warning from the U.S. Food and Drug Administration concerning risk of suicidal thoughts and behavior in children and adolescents. […] Medication effectiveness and adverse events should be monitored regularly because of the limited evidence for preventive treatment and unclear guidance about when treatment should be stopped. […] In children, comorbid negative emotional states such as anxiety, depression, or mental distress do not increase the risk of developing recurrent headache, based on findings of a high-quality systematic review. However, these emotional states increase the risk of headache persistence in patients who experience recurrent headache.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  ● CGRP monoclonal antibodies have been approved for the prevention of the attacks of migraine (both chronic and nonchronic) in adults; studies in children and adolescents are ongoing. […] CGRP antagonists („gepants”) have been approved for the prevention of attacks of migraine in adults. Studies are being initiated for children and adolescents. […] ● Devices that are being investigated for the prevention of migraine in children and adolescents include transcutaneous electrical nerve stimulation (brand name: Cefaly), vagus nerve stimulation (brand name: GammaCore), transmagnetic stimulation (brand name: eNeura), and conditioned pain modulation (brand name: Nerivio). Nerivio and GammaCore are approved for use in adolescents. Cefaly is available over the counter in the United States. […] The choice among these treatments will depend upon the age and characteristics of the individual child.

• #1 Prevention of Episodic Migraine in Children: Is Fremanezumab Safe and Effective?

  https://www.clinicalpainadvisor.com/news/prevention-episodic-migraine-children-frenmanezumab-safe-effective/

  Fremanezumab is effective and safe for the treatment of pediatric episodic migraine, according to study results presented at the 2025 American Academy of Neurology (AAN) annual meeting, held from April 5 to 9, 2025, in San Diego, California. […] These findings demonstrate the efficacy, safety, and tolerability of fremanezumab in children and adolescents with EM. […] In the secondary analyses, fremanezumab associated with a significant reduction in the number of monthly headache days of at least moderate severity (LSMD, -2.6 vs -1.5 days; P =.0172) and a greater proportion of those who received fremanezumab achieved a 50% or greater reduction in MMD (47.2% vs 27.0%; P =.0016) compared with placebo, respectively. […] These findings demonstrate the efficacy, safety, and tolerability of fremanezumab in children and adolescents with [episodic migraine], the researchers concluded.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/treatments/Pages/Natural-Therapies-for-Children-with-Chronic-Headaches.aspx

  Guided imagery, self-hypnosis, or relaxation can be helpful for preventing headaches. […] All dietary supplements should be discussed with the child’s pediatrician before use. […] Riboflavin is a B-vitamin that may reduce the number of headaches and pain. […] Magnesium supplements may also help reduce the number of headaches if taken for several months. […] Coenzyme Q10 (CoQ10) is an antioxidant present in each cell of our bodies; however, it was found to be deficient in one third of children with migraines. […] Butterbur is an herb extract that may reduce the number and severity of migraine headaches. […] If you’ve made the decision to seek a natural therapy for your child’s headaches, it is of utmost importance to involve your child’s pediatrician in the process.

• #1 Riboflavin prophylaxis in pediatric and adolescent migraine | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-009-0142-2

  Migraine is a common disorder in childhood and adolescence. […] In such cases, a prophylactic treatment is necessary to avoid excessive drug intake, and improve the quality of life. […] Riboflavin seems to be a well-tolerated, effective, and low-cost prophylactic treatment in children and adolescents suffering from migraine. […] At present, there are no further studies about riboflavin prophylaxis in pediatric migraine. […] Our data suggest that riboflavin prophylactic treatment significantly reduces migraine frequency and intensity during the trial (3-month treatment, Phase 2) and also in the follow-up (Phase 3). […] Our recommendation to parents and patients about an immediate symptomatic pharmacological intervention during riboflavin treatment could have influenced positively the results about headache intensity; in fact in 77.1% of patients there was an increase of symptomatic therapy responsiveness.

• #1 How to treat children with migraine in primary care – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – Arrow

  https://migrainetrust.org/migraine-in-children-and-young-people/how-you-can-help-a-young-patient-with-migraine/how-to-treat-children-with-migraine-in-primary-care/

  Where migraine attacks are frequent, and when they are impacting a child’s life, preventive treatment can be considered and advice from a headache specialist sought. This can be from another GP with a special interest in headache or a neurologist that is a headache specialist, or a paediatrician. […] Propranolol hydrochloride and topiramate can be used for the prevention of migraine in children. Females of childbearing potential should be warned of the associated risks of taking topiramate during pregnancy, and this should be considered when prescribing it. […] The effectiveness of preventive migraine treatment should be reviewed after six months as it is often possible to stop its use after a period of treatment.

• #1

  https://myhealth.alberta.ca/alberta/Pages/medications-to-prevent-migraines-in-children.aspx

  Preventive medicines are used to reduce how many and how serious migraine attacks are in children. They help make the brain less sensitive to pain, which can prevent some migraine attacks and make them less painful. […] Your child’s healthcare provider might recommend preventive medicines if your child has more than 4 migraine attacks per month. Preventive medicine can help lower the number of migraine attacks your child gets by half or more. […] Most children dont need preventive medicine for the rest of their lives. They usually take it for about 12 months and stop once they have fewer migraine attacks. […] Preventive medicines are generally used in low doses to prevent migraine attacks, so their side effects tend to be mild.

• #1 Pediatric Headache Treatment & Management: Approach Considerations, Treatment of Migraine and Tension-Type Headaches, Treatment of Chronic Daily Headache

  https://emedicine.medscape.com/article/2110861-treatment

  Migraines are known to remit spontaneously in some patients during childhood. […] Every 6-12 months, reassess the need for continued prophylaxis. […] Parents and patients need to be aware that migraine headaches may be a lifelong condition, and they should expect that the headaches will reappear at some time during a patient’s lifetime, especially during situations of increased stress, such as puberty, marriage, or change of job.

• #1 Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6646427/

  Migraine prophylaxis aims at reducing the impact of migraine by improving the frequency and intensity of attacks. In children and adolescents, it should be considered when the frequency of attacks is higher than 4 attacks per month or the response to the symptomatic treatment is not satisfactory. […] Here, our aim is to investigate the actual evidence concerning prophylactic therapy of pediatric migraine by reviewing clinical studies published between 2010 and 2019. […] Despite the widespread use in clinical practice, there are few RCTs available for these substances. Thus, the level of evidence remains low (level b or c), as well as the recommendation (class III). […] The choice of a non-pharmacological therapy should be reserved for patients who have failed drug therapies or, as a first line treatment, in patients who cannot tolerate the side effects of drugs. However, most published studies on non-pharmacological treatments have been carried out in adults, while definite results in children and adolescents are still lacking. Therefore, further confirmation with rigorous randomized controlled trials is mandatory for the majority of these approaches.

• #1 Migraine in Children: Preventive Pharmacologic Treatments | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/migraine-prevention/research

  Prevention of episodic migraine in children was examined in 24 publications of randomized controlled trials (RCTs) that enrolled 1,578 children and in 16 nonrandomized studies. […] Limited low-strength evidence suggests that propranolol was more effective than placebo for preventing episodic migraine in children, with no bothersome adverse effects that could lead to treatment discontinuation. […] Long-term preventive benefits are unknown both for drugs and nonpharmacologic interventions. […] Future randomized trials of drugs with favorable benefits-to-harms ratio in adults are needed to identify effective and safe treatments to prevent episodic and chronic migraine in children.

• #1

  https://link.springer.com/article/10.1007/s40272-015-0125-5

  While it has been established that headaches in the pediatric age group are relatively common, the characterization of headache disorders and their treatment in this group has historically been limited. […] Although it appears that many prophylactic agents are safe, well tolerated and efficacious in children, currently only topiramate is FDA-approved for use in patients 12 years and over. […] One-third of adolescents meet the criteria for warranting prophylactic therapy, yet few are offered a preventative medication. […] A diverse group of medications are used to prevent migraine attacks, including antidepressants, antiepileptics, antihistamines and antihypertensive agents, yet there still remains a serious lack of controlled studies on the pharmacological treatment of pediatric migraine.

• #1

  https://www.sangpediatrics.com/safe-home-remedies-and-treatments-for-children-s-migraines-and-headaches

  There are headache home remedies that can help ease the pain and reduce their frequency. Here are ten ways: […] Rest is the best among the natural remedies for children’s headaches. If their head hurts, it’s essential to let them rest and avoid activities that might worsen the pain. […] Massaging your child’s head can help relieve some of the pressure that causes a headache. […] Many children experience headaches when they have not been drinking enough fluids or have become dehydrated. […] Apply heat to the back of your child’s neck and forehead using a heating pad or warm washcloth for about 10 minutes every hour until he starts feeling better. […] Give your child a cool compress to help relieve pressure and pain. […] The most common treatment for migraines is medication. Over-the-counter medications such as ibuprofen (Advil) or acetaminophen (Tylenol) can help decrease pain and fever.

• #1 Addressing Headaches in Children: Prevention and Treatment Strategies – Le Bonheur Children’s Hospital

  https://www.lebonheur.org/blogs/practical-parenting/addressing-headaches-in-children-prevention-and-treatment-strategies

  Many headaches in kids can be prevented by a healthy and active lifestyle. A good place to start is ensuring that your child is following a healthy diet, staying hydrated and sleeping well. […] I tell my patients relentlessly about making lifestyle modifications, which they can do at home from the very beginning to prevent the threshold and frequency of headaches, states Dr. Ghosh. […] During every visit, we teach patients about acute and preventative management, some lifestyle changes they can make to decrease the frequency of headaches, and how to know what triggers might be and how to avoid them, notes Dr. Ghosh. […] In total, we believe in educating kids and taking a holistic approach, she adds.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  HEADACHE TREATMENT […] The treatment of headaches depends upon the child’s age, the type and frequency of headaches, and other factors. […] Illness- or injury-related headache treatment — A child who has a headache caused by an underlying illness or minor head injury should have the underlying illness treated. The headache can be treated similarly to that in a child with a tension-type headache (TTH). (See 'Infrequent TTH’ below.) […] However, it is important to be aware of signs and symptoms that could indicate a more serious condition, which should be evaluated by a health care provider. (See 'When to seek help’ above.) […] Tension-type headache treatment […] Infrequent TTH — Infrequent tension-type headache (TTH) is defined as occurring less than once per month. Children with infrequent tension-type headaches may be treated with an over-the-counter (OTC) pain medication, such as children’s acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). Aspirin is not recommended in children who are less than 16 years old due to the risk of a rare but serious condition called Reye syndrome. The dose of acetaminophen (10 to 15 mg/kg per dose) and ibuprofen (7.5 to 10 mg/kg per dose) should be based upon the child’s weight, rather than age.

• #1 Migraine in Children and Adolescents

  https://practicalneurology.com/articles/2023-may-june/migraine-in-children-and-adolescents

  When patients are hesitant to use pharmaceuticals for migraine prevention, there is evidence that nutraceuticals such as riboflavin or magnesium can be alternatives. […] A nutraceutical also may improve the results of migraine prevention medications. […] Pharmaceuticals for prevention of pediatric migraine include topiramate, propranolol, and amitriptyline. […] Available evidence supports the use of a combined pharmacotherapy and behavioral approach for migraine prevention in children and adolescents. […] The health care provider must understand the role of therapies such as cognitive-behavioral therapy in helping young patients manage headache pain, and to consider these therapies not only as adjunctive treatment but also as first-line treatment for the management of migraines in children and adolescents.

• #1 Treatment Considerations for Headache in Pediatric Patients

  https://www.uspharmacist.com/article/treatment-considerations-for-headache-in-pediatric-patients

  Pediatric patients commonly present with various types of headaches, acutely or chronically. Each patient has individual risk factors and qualifying components that contribute to diagnosis, warranting strategic nonpharmacologic and pharmacologic treatment. Nonpharmacologic techniques can be attempted, with ibuprofen as the most common pharmacologic treatment. Other options may be preferred depending on the individual patient, risk factors, and diagnoses. Pharmacologic options for treatment of chronic headaches are even more vast; complementary and alternative medications have been utilized with relatively unsupported evidence. The management of acute or chronic pediatric headache opens up considerable treatment options for practicing pharmacists. […] Therapy should always start with the nonpharmacologic component, especially since many children do not require pharmacologic treatment at all. If pharmacologic treatment is necessary, the goal is to treat early, appropriately, and effectively. Educating the patient and parents about the potential longevity of treatment for a chronic diagnosis is also crucial to successful treatment. Ultimately, the goal of treatment is to improve quality of life.

• #1 Headache – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/headache/

  For children who need more help with managing worry, counseling and special types of therapy can be useful. These special therapies include cognitive behavioral therapy (CBT) and biofeedback relaxation therapy. Both CBT and biofeedback have also been shown effective at preventing headaches. […] If a child has very frequent headaches or if the headaches are very severe, a daily prevention medication may be needed. There are many different medicines used to prevent headaches. Most of them were developed to treat other conditions first. The medicines are usually started at a low dose and increased slowly to reduce the chance of side effects. […] Treatment with daily prevention medicines is usually continued until the goal of one headache or less per week has been met for several months. […] It is important to work with a child’s doctor to come up with an effective treatment plan as soon as possible. Headaches can become more difficult to control the longer they go untreated. In addition, studies have shown that early treatment leads to a better lifelong outcome.

• #2 San Diego Pediatricians | Children’s Primary Care Medical Group » Archive » FIVE FAQS ABOUT KIDS & HEADACHES

  https://www.cpcmg.net/five-faqs-about-kids-headaches/

  Headaches are one of the top five health problems in childhood, with over half of children and adolescents developing headaches at some point. Here are some things that every parent should know in order to help their child, and to help determine when it’s time to see your doctor. […] If headaches can be prevented by avoiding the child’s triggers, that is certainly ideal. For example, if the child’s trigger is fasting or dehydration, making sure that they always have a backup snack and a water bottle available can be very helpful. When a headache happens, it’s important to give pain medication as soon as the headache becomes noticeable – the bigger the headache, the longer it takes for the child to feel better, even with the proper medication. Lifestyle modifications can also reduce headache burden. Sleep hygiene, daily exercise, stress reduction, and avoiding dehydration can all be helpful. Visit our blog post on preventing headaches for more information.

• #2 Headaches in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/symptoms-causes/syc-20352099

  The following may help you prevent headaches or reduce the severity of headaches in children: […] Practice healthy behaviors. Behaviors that promote general good health also may help prevent headaches for your child. These lifestyle measures include getting plenty of sleep, staying physically active, eating healthy meals and snacks, drinking up to eight glasses of water daily, and limiting caffeine. […] Reduce stress. Stress and busy schedules may increase the frequency of headaches. Be alert for things that may cause stress in your child’s life, such as difficulty doing schoolwork or strained relationships with peers. If your child’s headaches are linked to anxiety or depression, consider talking to a counselor. […] Keep a headache diary. A diary can help you determine what causes your child’s headaches. Note when the headaches start, how long they last and what, if anything, provides relief.

• #2 Migraines in Children: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/9637-migraines-in-children-and-adolescents

  Pediatric migraine prevention starts with maintaining a healthy lifestyle. Make sure your child is getting an adequate amount of sleep and managing their stress levels. In addition, your child should eat a healthy diet and make sure to exercise regularly. […] Beyond leading a healthy lifestyle, the best way to prevent migraines is to avoid known triggers. Keeping a headache diary can help track triggers so your child can try to avoid them in the future.

• #2 St. Petersburg: Pediatric Headaches: Causes, Prevention & Treatment for Your Child’s Pain Relief – Your Kid’s Urgent Care

  https://yourkidsurgentcare.com/pediatric-headaches-childs-pain-relief/

  Help your child identify and avoid potential headache triggers by keeping a headache diary documenting episodes, potential causes, and any patterns. […] By understanding the types and causes of pediatric headaches, enforcing effective prevention methods, and providing symptom relief through tailored treatment approaches, St. Petersburg parents can play a pivotal role in enhancing their child’s quality of life and overall well-being.

• #2 Headache

  https://www.rch.org.au/clinicalguide/guideline_index/headache/

  Children presenting with headache require careful assessment for red flag features, in order to detect serious underlying secondary causes […] Most children presenting with headache do not require investigations […] Supportive therapy with simple analgesia is the mainstay of treatment for most cases of primary headache; opioids are not recommended […] Ensure adequate hydration […] Encourage good sleep hygiene and a healthy exercise pattern […] To prevent medication overuse headache, limit use of simple analgesics to less than 15 days per month, and triptans to less than 10 days per month […] Avoid triggers […] Address emotional stressors which may be precipitating the headache […] A headache diary or App can be used to monitor response to lifestyle modifications and treatment

• #2 Headache

  https://www.seattlechildrens.org/conditions/a-z/headache/

  Headaches are very common with some viral illnesses. Most often, these will go away in 2 or 3 days. […] Most recurrent headaches that can occur in anyone are muscle tension headaches. […] Most headaches (including muscle tension headaches) are helped by the following measures. […] If something bothers your child, help him talk about it. Help him get it off his mind. […] Teach your child to take breaks when he is doing school work. Help your child to relax during these breaks. […] Teach your child the importance of getting enough sleep. […] Some children may feel pressure to achieve more. This may cause headaches. If this is the case with your child, help him find a better balance. […] Caution: frequent headaches are often caused by too much stress or worry. To be sure, get your child a medical checkup first. […] If your child’s doctor has prescribed a medicine for migraines, use it as directed. Give it as soon as the migraine starts. […] Drink lots of fluids. […] Don’t skip meals. […] Get enough sleep each night.

• #2 St. Petersburg: Pediatric Headaches: Causes, Prevention & Treatment for Your Child’s Pain Relief – Your Kid’s Urgent Care

  https://yourkidsurgentcare.com/pediatric-headaches-childs-pain-relief/

  When it comes to pediatric headaches, recognizing the potential triggers and causes, adopting effective prevention techniques, and implementing appropriate treatments can be the key to reducing the frequency and severity of headache episodes. […] To minimize the frequency and severity of headaches in your child, consider implementing the following prevention strategies: […] Encourage a consistent sleep schedule, regular meal times, and adequate hydration. […] Teach your child relaxation techniques, such as deep breathing and progressive muscle relaxation, to help cope with stress or anxiety. […] Regular exercise has been shown to reduce headache frequency and intensity in some children. […] Ensure your child’s room and study area have suitable lighting, ventilation, and an ergonomically friendly setup to minimize triggers.

• #2 Treatment Considerations for Headache in Pediatric Patients

  https://www.uspharmacist.com/article/treatment-considerations-for-headache-in-pediatric-patients

  Ensuring healthy lifestyle habits, such as eating breakfast, staying hydrated with water, getting enough sleep, exercise, and full school participation, can decrease frequency and intensity of headaches. […] Management through techniques such as biofeedback, acupuncture, hypnosis (especially self-hypnosis), and cognitive behavioral therapy (CBT) has been shown to decrease stress-induced headaches in 50% to 75% of patients. […] Once the requirement for pharmacologic treatment has been established, there are two components to consider: rescue therapy and prophylactic therapy. […] Chronic treatment is additionally indicated when a Pediatric Migraine Disability Assessment Score (PedMIDAS) is determined and indicates the need for daily prophylaxis. […] The use of neutraceuticals should also be strategically and cautiously considered. The treatment of pediatric headache has not drastically changed over the years, but the need for continued studies and research exists and is rather urgent considering the sizable number of patients impacted by headaches.

• #2

  https://www.healthychildren.org/English/health-issues/conditions/treatments/Pages/Natural-Therapies-for-Children-with-Chronic-Headaches.aspx

  Guided imagery, self-hypnosis, or relaxation can be helpful for preventing headaches. […] All dietary supplements should be discussed with the child’s pediatrician before use. […] Riboflavin is a B-vitamin that may reduce the number of headaches and pain. […] Magnesium supplements may also help reduce the number of headaches if taken for several months. […] Coenzyme Q10 (CoQ10) is an antioxidant present in each cell of our bodies; however, it was found to be deficient in one third of children with migraines. […] Butterbur is an herb extract that may reduce the number and severity of migraine headaches. […] If you’ve made the decision to seek a natural therapy for your child’s headaches, it is of utmost importance to involve your child’s pediatrician in the process.

• #2 Addressing Headaches in Children: Prevention and Treatment Strategies

  https://support.doctorpodcasting.com/client/lebonheur/item/46749-addressing-headaches-in-children-prevention-and-treatment-strategies

  So we have a comprehensive headache center here at Le Bonheur Children’s Hospital. And we actually practice our goal, which is as a team, we just don’t want to treat kids with medications, but actually educate them about the headache disorder. I think that is the most important thing, what we can do for them, so that they feel empowered to get help promptly. […] I always encourage parents who have children with migraine or any other headache disorder to have a chat at school. Because the more we educate schools, the more they would be empathetic and understanding, and we could reduce the impact on school attendance badly. So whenever we see any patient, we actually give a patient something like a school letter, which states that whenever they feel like they’re going to have their migraine attack or the headaches is coming up, they could sit in a quiet dark place, they can get their acute abortive medication, which has been prescribed to them and rest for a while. And that is very important because, most importantly, I think like rest and drinking water at that time and getting like medication on time is really important when you are in school so that you can feel more functional you can function as a normal kid. So we also give resources to parents to help them advocate for their children.

• #2

  https://myhealth.alberta.ca/alberta/Pages/medications-to-prevent-migraines-in-children.aspx

  Preventive medicines are used to reduce how many and how serious migraine attacks are in children. They help make the brain less sensitive to pain, which can prevent some migraine attacks and make them less painful. […] Your child’s healthcare provider might recommend preventive medicines if your child has more than 4 migraine attacks per month. Preventive medicine can help lower the number of migraine attacks your child gets by half or more. […] Most children dont need preventive medicine for the rest of their lives. They usually take it for about 12 months and stop once they have fewer migraine attacks. […] Preventive medicines are generally used in low doses to prevent migraine attacks, so their side effects tend to be mild.

• #2 Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6646427/

  Migraine prophylaxis aims at reducing the impact of migraine by improving the frequency and intensity of attacks. In children and adolescents, it should be considered when the frequency of attacks is higher than 4 attacks per month or the response to the symptomatic treatment is not satisfactory. […] Here, our aim is to investigate the actual evidence concerning prophylactic therapy of pediatric migraine by reviewing clinical studies published between 2010 and 2019. […] Despite the widespread use in clinical practice, there are few RCTs available for these substances. Thus, the level of evidence remains low (level b or c), as well as the recommendation (class III). […] The choice of a non-pharmacological therapy should be reserved for patients who have failed drug therapies or, as a first line treatment, in patients who cannot tolerate the side effects of drugs. However, most published studies on non-pharmacological treatments have been carried out in adults, while definite results in children and adolescents are still lacking. Therefore, further confirmation with rigorous randomized controlled trials is mandatory for the majority of these approaches.

• #2 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  ● Amitriptyline (sample brand name: Elavil) is a tricyclic antidepressant that, when given at low doses, can help to reduce the frequency, severity, and duration of headaches. Its most common side effect is sleepiness. For this reason, it is usually given at dinnertime or bedtime to lessen morning sleepiness so that children may attend school. The dose may be increased slowly over time as needed. […] ● Antiepileptic medications such as topiramate (brand name: Topamax) and valproate (brand name: Depakote) are frequently given to prevent attacks of migraine in adults. Topiramate is approved by the FDA for the prevention of attacks of migraine in 12 to 17 year olds. The main side effects of topiramate are cognitive slowing, tingling extremities, kidney stones, and weight loss. The main side effects of valproate are weight gain, ovarian cysts, rash, and platelet dysfunction.

• #2 Migraines in Children: Recommendations for Acute and Preventive Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p569.html

  Preventive pharmacologic medications were not superior to placebo in most randomized controlled trials, yet the placebo response is high. […] Although amitriptyline combined with CBT has been shown to be more effective than amitriptyline without CBT, amitriptyline has a boxed warning from the U.S. Food and Drug Administration concerning risk of suicidal thoughts and behavior in children and adolescents. […] Medication effectiveness and adverse events should be monitored regularly because of the limited evidence for preventive treatment and unclear guidance about when treatment should be stopped. […] In children, comorbid negative emotional states such as anxiety, depression, or mental distress do not increase the risk of developing recurrent headache, based on findings of a high-quality systematic review. However, these emotional states increase the risk of headache persistence in patients who experience recurrent headache.

• #2 Prevention of Episodic Migraine in Children: Is Fremanezumab Safe and Effective? – Neurology Advisor

  https://www.neurologyadvisor.com/reports/prevention-episodic-migraine-children-frenmanezumab-safe-effective/

  Fremanezumab is effective and safe for the treatment of pediatric episodic migraine, according to study results presented at the 2025 American Academy of Neurology (AAN) annual meeting, held from April 5 to 9, 2025, in San Diego, California. […] These findings demonstrate the efficacy, safety, and tolerability of fremanezumab in children and adolescents with EM. […] These findings demonstrate the efficacy, safety, and tolerability of fremanezumab in children and adolescents with [episodic migraine], the researchers concluded.

• #2 Migraine in Children and Adolescents

  https://practicalneurology.com/articles/2023-may-june/migraine-in-children-and-adolescents

  When patients are hesitant to use pharmaceuticals for migraine prevention, there is evidence that nutraceuticals such as riboflavin or magnesium can be alternatives. […] A nutraceutical also may improve the results of migraine prevention medications. […] Pharmaceuticals for prevention of pediatric migraine include topiramate, propranolol, and amitriptyline. […] Available evidence supports the use of a combined pharmacotherapy and behavioral approach for migraine prevention in children and adolescents. […] The health care provider must understand the role of therapies such as cognitive-behavioral therapy in helping young patients manage headache pain, and to consider these therapies not only as adjunctive treatment but also as first-line treatment for the management of migraines in children and adolescents.

• #2 Addressing Headaches in Children: Prevention and Treatment Strategies

  https://support.doctorpodcasting.com/client/lebonheur/item/46749-addressing-headaches-in-children-prevention-and-treatment-strategies

  There are several kinds of headaches. Chronic, migraine, tension, just to name a few. But when your child is suffering from one, how do you know if it’s a more serious type and what can you do to prevent them. […] I tell my patients relentlessly about making lifestyle modifications, which they can do at home from the very beginning to prevent the threshold and frequency of headaches. So I always recommend all my patients to eat regularly three meals a day and have some snacks in between. This is very important because we all need steady balance of glucose and, when someone skips meals, that could lead to more headaches. I also recommend adding green vegetables, dairy and protein in the diet. This is because green vegetables are high in folic acid and vitamin B2, which is also called as riboflavin. Dairy products are rich in vitamin D and protein such as meat, or if someone is vegetarian, like tofu, beans, et cetera, has coenzyme Q10. So there is now evidence that these vitamins are very beneficial for migraine and headaches in general. I also recommend adding these vitamin supplements in diet through daily multivitamins. And exercising at least three times a week is definitely recommended. helps with mood, anxiety, depression, migraine headaches as well, it helps your brain to secrete a really good hormone called endorphins, which helps you to stay motivated and happy in life. And lastly, keeping yourself very well-hydrated with drinking water. I would suggest like at least eight to ten glasses a day maintaining sleep hygiene is very critical and important.

• #2 Riboflavin prophylaxis in pediatric and adolescent migraine | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-009-0142-2

  Our results suggest that riboflavin may be effective for any type of migraine, with any onset age, in childhood and adolescence. […] In conclusion, we suggest that riboflavin might be a safe, well-tolerated, and effective alternative prophylactic treatment for children and adolescents with migraine.

• #2 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Only flunarizine has sufficient evidence to be considered probably effective for migraine prevention in children, but it is not available in the United States. […] Agents commonly prescribed for children, such as propranolol and topiramate, have conflicting results in studies. […] Other agents, including cyproheptadine, amitriptyline, valproic acid (Depakene), and levetiracetam (Keppra), have insufficient data in children. […] More quality randomized controlled trials are needed in this population.

• #2

  https://link.springer.com/article/10.1007/s40272-015-0125-5

  While it has been established that headaches in the pediatric age group are relatively common, the characterization of headache disorders and their treatment in this group has historically been limited. […] Although it appears that many prophylactic agents are safe, well tolerated and efficacious in children, currently only topiramate is FDA-approved for use in patients 12 years and over. […] One-third of adolescents meet the criteria for warranting prophylactic therapy, yet few are offered a preventative medication. […] A diverse group of medications are used to prevent migraine attacks, including antidepressants, antiepileptics, antihistamines and antihypertensive agents, yet there still remains a serious lack of controlled studies on the pharmacological treatment of pediatric migraine.

• #2

  https://www.sangpediatrics.com/safe-home-remedies-and-treatments-for-children-s-migraines-and-headaches

  Find out what triggers your child’s headaches and try to avoid them as much as possible. […] A child’s frequent headaches or migraines may be due to allergies. […] Help your child relax by playing music or reading together. […] Aromatherapy is another effective natural headache remedy for a child experiencing headaches. Essential oils, including lavender, eucalyptus, and peppermint, help relieve pain and anxiety. […] If your child experiences migraines frequently enough to interfere with daily life, talk to our doctor, so they can rule out any serious medical conditions and prescribe the necessary treatment.

• #2 Addressing Headaches in Children: Prevention and Treatment Strategies – Le Bonheur Children’s Hospital

  https://www.lebonheur.org/blogs/practical-parenting/addressing-headaches-in-children-prevention-and-treatment-strategies

  Many headaches in kids can be prevented by a healthy and active lifestyle. A good place to start is ensuring that your child is following a healthy diet, staying hydrated and sleeping well. […] I tell my patients relentlessly about making lifestyle modifications, which they can do at home from the very beginning to prevent the threshold and frequency of headaches, states Dr. Ghosh. […] During every visit, we teach patients about acute and preventative management, some lifestyle changes they can make to decrease the frequency of headaches, and how to know what triggers might be and how to avoid them, notes Dr. Ghosh. […] In total, we believe in educating kids and taking a holistic approach, she adds.

• #2 Headache – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/headache/

  Headaches are very common in childhood. Most of the time, children have headaches for the same reasons adults do. Just as for adults, stress or poor sleep can cause headaches. Headaches can affect a child’s functioning at school and play if they are frequent or severe. Even so, headaches are usually not due to serious illness. […] Practicing healthy habits like drinking enough water and getting regular sleep can help prevent headaches. […] Even if headaches are infrequent, it is important to have an effective headache treatment plan in place. If left untreated, headaches can become more difficult to treat and eventually cause disability. […] Many children can achieve good control of their headaches by practicing healthy habits every day. These healthy habits include: Drinking lots of water and other fluids. For most older children and teenagers, this is usually 8 to 10 eight-ounce glasses of fluid per day. Avoid drinks with caffeine, such as coffee and some sodas. Eating three healthy meals per day. A healthy meal includes lots of fruits and vegetables. Avoid skipping breakfast. Getting enough exercise. The American Academy of Pediatrics recommends at least one hour of activity every day for most children. Getting consistent sleep every night. School-aged children need between 9 and 12 hours of sleep every night. Teenagers should get between 8 and 10 hours every night. On weekends, children and teenagers should go to sleep no more than an hour later than their usual bedtime.

• #2 Headache – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/headache/

  For children who need more help with managing worry, counseling and special types of therapy can be useful. These special therapies include cognitive behavioral therapy (CBT) and biofeedback relaxation therapy. Both CBT and biofeedback have also been shown effective at preventing headaches. […] If a child has very frequent headaches or if the headaches are very severe, a daily prevention medication may be needed. There are many different medicines used to prevent headaches. Most of them were developed to treat other conditions first. The medicines are usually started at a low dose and increased slowly to reduce the chance of side effects. […] Treatment with daily prevention medicines is usually continued until the goal of one headache or less per week has been met for several months. […] It is important to work with a child’s doctor to come up with an effective treatment plan as soon as possible. Headaches can become more difficult to control the longer they go untreated. In addition, studies have shown that early treatment leads to a better lifelong outcome.

• #3 Migraines in Children: Recommendations for Acute and Preventive Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p569.html

  No medications have been shown to be more effective than placebo for preventing migraine in children and adolescents. […] CBT appears to be effective for reducing migraine frequency in children and adolescents. […] Prevention should be considered if headaches occur frequently, are severe, and result in significant disability. […] Counseling and education are important for patients and their families, especially because of the lack of useful pharmacologic therapy. […] Behavioral factors that influence the frequency of headaches in adolescents are obesity and overweight, caffeine and alcohol use, lack of physical activity, poor sleeping habits, and tobacco exposure. […] Losing weight has been shown to reduce headaches in overweight children. […] Consider trigger avoidance for children and adolescents who have frequent headaches or migraine-related disabilities.

• #3 Migraine Headaches in Children | The Children’s Hospital at Montefiore

  https://www.cham.org/health-library/article?id=acp3502

  To prevent migraine headaches in your child, try these tips. […] Keep a headache diary. This can help you figure out what triggers your child’s headaches. […] Make sure that your child drinks plenty of fluids. Avoid drinks that have caffeine. […] Make sure that your child gets plenty of sleep. Most children need to sleep about 9 to 14 hours each night, depending on their age. […] Encourage your child to get plenty of exercise. But make sure your child doesn’t exercise too hard. It may trigger a headache. […] Encourage your child not to skip meals. Provide regular, healthy meals. […] Keep your child away from smoke. Do not smoke or let anyone else smoke around your child or in your house. […] Find healthy ways to deal with stress. Do not overbook your child’s time. […] Seek help if you think your child may be depressed or anxious. Treating these problems may reduce the number of migraines your child has. […] Limit the amount of time your child spends in front of the TV and computer.

• #3 Efficacy and tolerability of the use gabapentin for migraine prophylaxis in children | Archives of Disease in Childhood

  https://adc.bmj.com/content/97/Suppl_1/A140.2

  Gabapentin is an effective agent for Migraine Prophylaxis in children. […] Side effects were infrequent and noted in only 1 out 12 children.

• #3 Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6646427/

  The main novelty of the last decade in the prophylaxis of pediatric migraine comes from the results of the CHAMP study. This study showed that pharmacological treatments, such as amitriptyline and topiramate, do not differ from placebo. […] Lastly, we must underline that there is no drug available in pediatric age with exclusive indication for migraine treatment. From this point of view, there is high expectation for the use of calcitonin gene-related peptide (CGRP) inhibitors (CGRP-r).

• #3 What causes migraine headaches in children? | Norton Children’s Louisville, Ky.

  https://nortonchildrens.com/news/causes-migraine-headaches-in-children/

  Your child should drink plenty of water throughout the day and not just when they feel thirsty. […] Take note of these times to ensure your child is avoiding other migraine triggers. […] Lifestyle factors (hydration, proper nutrition, stress reduction, exercise, good sleep, etc.) play a major role in migraine prevention. […] Several over-the-counter supplements have shown to help prevent migraine, including magnesium oxide, coenzyme Q10 and riboflavin. […] If a child continues to deal with migraine despite avoiding triggers or implementing healthy lifestyle habits a pediatrician or neurologist can help with management. […] Help is available for children who experience migraine on a regular basis. Check in with your child’s pediatrician. They can start treatment for migraine. If the headaches continue, your pediatrician can refer your child to Norton Children’s Neuroscience Institute for migraine treatment and prevention.

• #3 Prophylaxis of Migraine in Children and Adolescents | springermedizin.de

  https://www.springermedizin.de/prophylaxis-of-migraine-in-children-and-adolescents/24128170

  While it has been established that headaches in the pediatric age group are relatively common, the characterization of headache disorders and their treatment in this group has historically been limited. […] Although it appears that many prophylactic agents are safe, well tolerated and efficacious in children, currently only topiramate is FDA-approved for use in patients 12 years and over. […] One-third of adolescents meet the criteria for warranting prophylactic therapy, yet few are offered a preventative medication. […] A diverse group of medications are used to prevent migraine attacks, including antidepressants, antiepileptics, antihistamines and antihypertensive agents, yet there still remains a serious lack of controlled studies on the pharmacological treatment of pediatric migraine.

• #4 Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6646427/

  Migraine prophylaxis aims at reducing the impact of migraine by improving the frequency and intensity of attacks. In children and adolescents, it should be considered when the frequency of attacks is higher than 4 attacks per month or the response to the symptomatic treatment is not satisfactory. […] Here, our aim is to investigate the actual evidence concerning prophylactic therapy of pediatric migraine by reviewing clinical studies published between 2010 and 2019. […] Despite the widespread use in clinical practice, there are few RCTs available for these substances. Thus, the level of evidence remains low (level b or c), as well as the recommendation (class III). […] The choice of a non-pharmacological therapy should be reserved for patients who have failed drug therapies or, as a first line treatment, in patients who cannot tolerate the side effects of drugs. However, most published studies on non-pharmacological treatments have been carried out in adults, while definite results in children and adolescents are still lacking. Therefore, further confirmation with rigorous randomized controlled trials is mandatory for the majority of these approaches.

• #4

  https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Migraine-Headaches-in-Children.aspx

  Preventive medications. There are some medications that when taken daily can help reduce the severity and/or frequency of migraines. These tend to be off-label, meaning they are not approved by the U.S. Food and Drug Administration for migraines. Their risks and benefits should be discussed with your doctor. Options include: […] Cardiovascular drugs: propranolol […] […] Antidepressants drugs: amitriptyline […] […] Anti-seizure drugs: topiramate […] […] Antihistamines: cyproheptadine […] Children who suffer from migraines are absent from school twice as often as other students. Talk with your child’s teachers and school nurse about ways to help avoid missed class time. A letter from the doctor explaining your child’s diagnosis and the medications they take when they feel a migraine coming on can help the conversation. Helpful accommodations may include making sure your child has ready access to water and snacks, for example.

• #5 Migraine in Children and Adolescents

  https://practicalneurology.com/articles/2023-may-june/migraine-in-children-and-adolescents

  The general principles of migraine prophylaxis are to reduce attack frequency, severity, and duration; improve responsiveness to treatment of acute attacks; improve function; and reduce disability.16 Using these guidelines can help provide a rationale for the institution of prophylaxis, such as in recurring migraines that cause daily disability, despite acute treatment; when frequency of attacks is greater than 4 per month; or a person has a contraindication to or has failed or overused acute therapies, has had adverse effects with acute therapies, or has an uncommon migraine condition, such as hemiplegic migraine.16 […] Pediatric and adolescent patients should have water intake goals, engage in some form of exercise 3 days per week,18 and receive sleep guidelines tailored to their developmental stage.4

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