First-Line Medications for Kids and Teens with Migraine

B.S. Dietetics, Dietitian, Health Professional
Medically Reviewed
iStock

Migraine attacks are a pain—a huge one. They affect over 13 million adults and as many as three percent of children. Yet the kinds of medications available to kids can be limited, especially for boys and girls under the age of 12. According to the Migraine Research Foundation, the FDA has approved very few medications for treating childhood migraine attacks, though doctors use several off-label.

Our daughter’s doctor prescribed a number of different medications for her that show the range of what's out there. This is not an exhaustive list, but it reveals the most common first options for children, especially under the age of 12.

Cyproheptadine

Cyproheptadine (Periactin) is one of the first medications that my daughter tried to lessen the frequency of her Migraine attacks. This antihistamine/antiserotonin drug has been successfully used for decades to treat pediatric Migraine patients, although there has been no research to assess its efficacy. The medication can also be sedating and may increase a child’s appetite or cause weight gain. Unfortunately, it did not help our daughter.

Antidepressants like amitriptyline

Amitriptyline and nortriptyline belong to the family of tricyclic antidepressants. While there is little research on nortriptyline and Migraine, the research on amitriptyline has shown it to be effective in preventing Migraine attacks in some children and teens.

Tricyclic antidepressants increase the levels of the neurotransmitters serotonin and norepinephrine in the brain by blocking their absorption. It is thought that dropping serotonin levels may trigger a Migraine attack which explains why antidepressants work for some people. Unfortunately, they did not do the trick for our little one with Migraine.

It’s important to note that prior to trying the amitriptyline, my daughter with Migraine had to have an Electrocardiogram (ECG) because antidepressants such as Amitriptyline can have the potential to cause an arrhythmia or heart block in individuals with preexisting problems.

Beta blockers and calcium channel blockers

Doctors have used both these medications to treat cardiovascular disease for many years, but expert opinion is split on the use of these drugs to treat childhood Migraine. The calcium channel blocker most frequently studied for Migraine, verapamil, works well for adult patients but doesn’t seem to have the same benefit in children. Beta blockers like propranolol and nadolol are each effective for some patients but cannot be use in children with asthma. So, I scratched those medications off my daughter’s list of options.

Anti-seizure medications

Doctors use valproic acid, zonisamide, and topiramate to prevent Migraine attacks, with some success. This type of medication is usually only prescribed if the previously discussed medications do not provide relief or cannot be used, or if the patient also has a seizure disorder. The FDA approved topiramate in 2012 for the prevention of headaches in patients with Migraine ages 12 to 17, and it is the medication my daughter with Migraine currently uses. It has not been a cure-all by any means but it does seem to lessen the frequency of her attacks from five per week down to two or three.

If your child has gone through multiple medications with no success, I highly recommend seeking the help of a neurologist or headache specialist. These experts can go further than a pediatrician can in treating children with Migraine. It may take some time to find the right combination of medications and to learn which triggers to avoid, but there is hope.

See more helpful articles:

Preventive, Abortive, and Rescue Medications - What's the Difference?

Teaching Others About Migraine - A Letter to Use

How Is Migraine Diagnosed?

Understanding the Anatomy of a Migraine