New Guidelines for Migraine Prevention in Children and Adolescents


Migraine is common in children and adolescents and is a significant cause of disability. Migraine adversely affects their studies, games and other recreational activities. Over the years, newer evidences have been generated and the current guidelines have incorporated them.

The key recommendations for prevention of headaches are:

  1. Topiramate is more effective than placebo in reducing headache frequency and severity.
  2. Propranolol are more effective than placebo.
  3. Amitriptyline combined with cognitive behavioural therapy is more effective than amitriptyline combined with headache education.
  4. There is insufficient evidence to assess the efficacy of amitriptyline (alone), botox injection and extended release divalproex sodium tablets.

Key recommendations regarding treatment of acute migraine attack are:

  1. Acute migraine treatments work best when started early, when the headache is still mild.
  2. For mild headache, ibuprofen oral solution (10 mg/kg) is recommended.
  3. For severe headache, effective options include: Sumatriptan/naproxen oral tablet, zolmitriptan nasal spray, rizatriptan oral disintegrating tablet or almotriptan oral tablet.

These guidelines were published in the journal Neurology, Aug/September 2019 issue and can be accessed at the following links:

  1. https://www.aan.com/Guidelines/home/GetGuidelineContent/970
  2. https://www.aan.com/Guidelines/home/GetGuidelineContent/971

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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