Migraines in Children: Time to Treat Like Little Adults?

Yesterday, we discussed new recommendations coming out of the American Academy of Pediatrics suggesting that we treat children & adolescents as little adults and offer metformin to those who are newly diagnosed with type 2 diabetes, in addition to the usual lifestyle modification recommendations.

So of course I read w/interest 2 studies published online earlier this week in JAMA Pediatrics in which the authors reviewed the literature looking at how to treat children & adolescents with headaches, especially migraines.  In the first review, the authors concluded that only topirimate & trazodone might have limited evidence supporting its use in children & adolescents suffering from migraines.  However, all other commonly used medications in adults lack any supportive data.  

In the second review, ostensibly a comparison of the various triptans available for use in adolescents, the authors were only able to conclude that 53-57% of migraine patients responded to placebo.  Given such a tremendous response rate, it's near impossible to prove efficacy of triptans in adolescents.

So while children & adolescents w/newly diagnosed diabetes may respond similarly to adult-based therapies, such is not the case in those w/migraines.  Those children & adolescents suffering from headaches need to be treated as children & adolescents, not little adults.  Much research needs to be performed in order to determine how best to help this population subset.

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