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Can taking medications or herbal products prevent migraine attacks in children and teenagers?

Last Update: March 30, 2012; Next update: 2015.

There is weak evidence that some medications can prevent migraines in children and teenagers. In Germany these drugs are not approved for use in children and teenagers because not enough research has been done on their safety and effectiveness.

Some people have occasional migraines, which can cause severe pain and make them feel ill. Migraine attacks can last for at least four hours in adults and teenagers. They take at least two hours in children, but are not as frequent. It is not yet known what exactly causes migraines.

Most children and teenagers can manage their migraines by changing their habits and using medication for pain relief when needed. But if the migraine attacks happen so often that they interfere with daily life, or if the medication does not provide enough relief, many young people and their parents try to find ways to prevent the migraine attacks.

Children and teenagers can try different approaches to stop some migraine attacks, including changing their habits, or learning relaxation techniques to better manage their migraines. It is not always easy to follow through with these treatments, and they do not always work. Some children and teenagers still have more than four migraines a month and the symptoms may be very severe, keeping them from going to school and doing other activities. If that is the case medication may be an option, even if it means taking medicine every day.

Medications are not yet approved in Germany for preventing migraines in children and teenagers

There are several medications that adults can use to prevent migraines, but this does not automatically mean that they will work for children too. Drugs can affect children's bodies differently, and children's migraines are different from the migraines adults get. This means that the results of research on migraine drugs in adults do not necessarily apply to children and teenagers.

Not many studies have been done on the prevention of migraine attacks in young people, and no drugs for preventing migraines in children and teenagers have been approved in Germany. The European Medicines Agency (EMA) is responsible for drug approval in Europe, and the U.S. Food and Drug Administration (FDA) performs this function in the United States. Some countries have approved a few drugs on their own, but most countries have not.

German regulators have not approved any medication for migraine prevention in children and teenagers because none of them have been categorized as safe and effective. If a drug has not been approved for use in children and teenagers, they can only use it "off-label." Off-label use is when a drug is used in a specific group of people or for a medical condition that it has not been approved for. Your doctor always needs to tell you if your medication has been prescribed for off-label use.

Medications and herbal products

There are several types of medicines used for preventing migraines in adults. They might also sometimes be prescribed off-label for children and teenagers. These are the main treatments that have also been tested in studies:

  • Antihypertensive (blood-pressure-lowering) drugs: These include calcium blockers (also called calcium-channel blockers) such as flunarizine. Another antihypertensive drug is a beta-blocker called propanolol. These drugs can cause a variety of side effects, including drowsiness, tiredness, stomach and bowel problems, and nausea.
  • Herbal products and dietary supplements: These include feverfew and dietary supplements containing magnesium and vitamin B2. Herbal products can also cause side effects.
  • Allergy medicines (antihistamines): These drugs block allergic reactions in various ways. One drug from this group, called pizotifen, is used in some countries to prevent migraines, but it is not available in Germany.
  • Antiepilepsy medicines (anticonvulsants): These drugs are sometimes used to prevent migraine attacks in people with severe migraines. One of these drugs is called topiramate. These drugs are usually used to treat epilepsy, a type of nervous disorder causing seizures. In Germany, anticonvulsants are not approved for preventing migraines in children and teenagers.

Research results on migraine prevention

Studies on migraine treatment in children and teenagers usually involve comparing a group of people taking one drug with another group taking a dummy treatment (placebo). This way, researchers can find out whether a drug is effective in treating migraine. For many children and teenagers, migraines will get better over time without treatment. Without doing a study that has a comparison group who do not take the medication, we cannot know whether the medication relieved the migraine or whether it went away on its own.

Researchers systematically analyzed studies that tested migraine prevention with medications in children and teenagers. They found 26 comparative studies that compared 15 different medications either with a placebo or with one of the other medications. Altogether, the studies involved about 1,200 children and teenagers between the ages of 3 and 18. The researchers found that there was not enough data on any one drug to be able to conclusively weigh the advantages and disadvantages with certainty.

There is weak evidence for three drugs that might be able to reduce the frequency of migraine attacks: flunarizine, propanolol, and topiramate. But there were no clear conclusions in these cases, either because not enough studies were available for a specific topic, the studies were too small, or some results were contradictory.

There has also not been enough research on herbal medicines to tell whether they can prevent migraines.

It is important to review any medication a child takes every few months. Because many children and teenagers grow out of their migraines, the problem may have lessened or gone away on its own for reasons besides the medication.

Sources

  • Bakola E, Skapinakis P, Tzoufi M, Damigos D, Mavreas V. Anticonvulsant drugs for pediatric migraine prevention: an evidence-based review. Eur J Pain 2009; 13(9): 893-901.
  • Damen L, Bruijn J, Verhagen AP, Berger MY, Passchier J, Koes BW. Prophylactic treatment of migraine in children. Part 2. A systematic review of pharmacological trials. Cephalalgia 2006; 26(5): 497-505.
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)
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