Pediatrics

AAN, AHS Issue Updated Guidelines for Pediatric Migraine

The American Academy of Neurology (AAN) and American Headache Society (AHS) have published updated guidelines on the prevention and treatment of migraine in children and adolescents. In the guidelines, the authors highlight that a key component in preventing and treating migraine is maintaining a strong patient-provider relationship.1

“Clinicians should engage in shared decision-making with patients and caregivers regarding the use of preventive treatments for migraine, including discussion of the limitations in the evidence to support pharmacologic treatments,” the authors wrote.

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The guidelines, which are an update of the recommendations the AAN published in 2004,2 come after the authors reviewed literature published from January 2003 to August 2017. In all, the authors identified 15 Class I to III studies on migraine prevention in children and adolescents to use as evidence for their clinical recommendations. 

The studies lacked sufficient evidence that preventive medications—including divalproex, onabotulinumtoxinA, amitriptyline, nimodipine, or flunarizine—had more or less of an impact on the frequency of migraine, compared with a placebo.  

However, there are medications that could more positively impact headache frequency than placebo. According to the authors, children with migraine who take propranolol may be more likely to have at least a 50% reduction in headache frequency compared with their counterparts taking placebo. Topiramate and cinnarizine may be able to better limit headache frequency than placebo, as well. 

Through their systematic review, the authors also determined that children with migraine who are taking amitriptyline are more likely to experience a reduction in headache frequency if a clinician provides cognitive behavioral therapy rather than headache education in addition to the medication.

All of these findings on the effectiveness of headache treatment is information the authors recommend clinicians share with patients and guardians. 

Counseling patients on lifestyle and behavioral factors that influence headache frequency is key in the prevention of pediatric migraine, as well. It is recommended that clinicians also assess for and manage patients’ comorbid disorders that are associated with headache persistence.

—Colleen Murphy

References:

  1. Oskoui M, Pringsheim T, Billinghurst L, 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 [published online August 14, 2019]. Neurology. doi:10.1212/WNL.0000000000008105.
  2. AAN issues guidelines for treatment of migraine in children and teens [press release]. Minneapolis, MN: American Academy of Neurology; August 14, 2019. https://www.aan.com/PressRoom/Home/PressRelease/2741. Accessed August 15, 2019.