Migraine Medications for Kids

There are safe and effective treatment options that can improve your child's migraines. Symptoms of childhood migraines include headaches, vomiting, stomach aches, irritability, and fatigue. Parents and children might not always recognize the effects of a migraine, but treating these episodes at an early stage can help alleviate hours, or even days, of pain and discomfort.

After you and your child discuss the symptoms with your child's pediatrician, you can agree about what to do when a migraine occurs. If the migraines are frequent, you may need to discuss a preventative strategy as well.

Pediatric Migraines: Kids Under 10

Migraines can begin as young as preschool age. About 3% of preschoolers are diagnosed with migraines. Migraines occur in about 4-11% of elementary school age children.

In children 10 years of age and younger, it is more common for migraine to be diagnosed in boys than girls. Typically, migraine symptoms start in late afternoon in this age group. This age group also tends to have head pain in the front of the head or on both sides.

Tweens and Teens

About 8-15% of high school age children are diagnosed with migraines. Migraines typically occur more often in boys until puberty; once puberty hits, girls have more migraines than boys. The hormone fluctuations in girls during puberty is likely why girls are more often diagnosed with migraines than boys in this age group.

As children enter the tween/teen stage, migraines tend to occur earlier in the morning. Unlike in younger children, the migraine head pain tends to be more intense in a focused area, usually one side of the head.

Medication Options

There are a number of over-the-counter (OTC) and prescription medications used for migraine treatment and prevention. Most kids improve with OTC treatment, but sometimes, a prescription is necessary to manage the symptoms.

Over-the-Counter

If your child complains of occasional head pain, you may have tried OTC pain relievers already. These, along with anti-nausea medications, are commonly used for childhood migraines. Before giving any medication, talk to your child's doctor about what medicines and dosages are appropriate for children their age. Never assume it's safe to give your child a lower dose of your own medication.

Children's doses of OTC medications are typically based on weight. Carefully read the instructions included on the box and use any included measuring cups for liquid formulations.

There are two types of OTC medicine commonly used to treat headaches in children. These include:

• Pain relievers: Tylenol (acetaminophen) and Advil (ibuprofen) are pain relievers that come in formulations for infants and young children. Aleve (naproxen), another commonly used pain reliever, is approved for children over the age of 12. When taken as directed, these pain medications can effectively relieve migraines in children.
• Anti-nausea drugs: For children, migraines can manifest with stomach discomfort, abdominal pain, aversion to food, nausea, or vomiting. Children's Benadryl (diphenhydramine) or Dramamine (dimenhydrinate) may relieve these symptoms, as well as headaches and pain. Anti-nausea medications can be used during a migraine attack or as a short-term preventative measure if your child often gets migraines after certain triggers, such as traveling on an airplane.

Ginger may also be helpful as a treatment for migraine nausea. Try incorporating ginger chews or ginger tea into your child's diet to relieve stomach upset or nausea during or right before a migraine. Talk to your child's pediatrician for more details.

Prescription

If your child's migraines do not improve with OTC pain medications, it may be time to consider prescription options. Some prescription medications are used for the treatment of migraine episodes, while a few can be used for migraine prevention.

If your child is having frequent tension headaches or migraines, their headaches may be considered chronic. This could be due to medication overuse. Overuse of some OTC painkillers can actually cause headaches. It may be worthwhile to discuss the idea of a preventative medication instead of frequently treating headache pain with OTC painkillers.

If your child has four or more migraines a month that cause disability, such as missing school or other activities, this could be another reason to consider preventative management.

Prescription options include two classes of medications: abortive (used during an active migraine attack) and preventative (used to try and stop a migraine before it starts):

Abortive medications:

• Anti-nausea medications: Prescription-strength antiemetics like Zofran (ondansetron) can relieve nausea and vomiting, as well as other migraine symptoms, such as headaches and neck pain. For children, they are usually used during a migraine attack.
• Triptans: Triptans are potent prescription medications used for the treatment of moderate to severe migraine episodes. A few triptans, including Zomig (zolmitriptan) nasal spray, Axert (almotriptan), and Maxalt (rizatriptan), are approved for children. Your child's doctor will give you specific instructions regarding how much your child should take, when and how often the dose can be repeated, and when to call about side effects.

Preventative medications:

• Amitriptyline: This medication, which is approved for use in children, has been shown to help treat chronic migraine in children and adolescents when combined with cognitive behavioral therapy.
• Periactin: An antihistamine, Periactin (cyproheptadine) has long been used as a preventative medication for childhood migraines. Because Periactin can increase appetite (causing weight gain), prescribing is generally limited to younger children.
• Anti-cGRPs: Although these drugs are not approved for use in children and adolescents, researchers are investigating their use in these groups. Aimovig (erenumab), Ajovy (fremanezumab), and Emgality (galcanezumab) are part of a new class of preventative migraine medications for adults taken as a monthly injection. Recommendations from the American Headache Society suggest limiting the use of anti-CGRPs to post-pubescent adolescents until more data becomes available.

Lifestyle Changes

With children and adolescents, recommendations from the American Academy of Neurology, endorsed by the American Academy of Pediatrics, start with understanding migraine triggers and eliminating as many of them as possible. In other words, getting the right amount of sleep based on age group, eating a health diet, and decreasing stress with exercise and biofeedback can eliminate the risk of migraine symptoms.

The first step with addressing migraines is often to identify what triggers might be causing migraine symptoms. Once it is understood what triggers can cause a migraine, avoiding the trigger(s) can reduce the intensity and duration of a migraine.

There are several methods that can be used to address migraine symptoms before considering medication management:

• Biofeedback is a coping tool which can assist a person with focus to reduce stress by relaxing muscle tension, reducing heart rate and gain control over the trigger(s) causing migraine symptoms.
• Exercise, such as yoga, can assist with regulating breathing and promoting relaxation, both of which are effective in decreasing migraine symptoms.
• Eating a health diet that contains magnesium, riboflavin, and coenzyme q10, all of which have been shown to be effective with reducing migraine symptoms.
• Resting in a quiet, darkened room and try to rest or applying a cooling method, such as ice or rag, to the painful area of the head can provide enough relaxation that the migraine symptoms can disappear.

Timing

Taking the medication right at the start of the symptoms is the best way to prevent a migraine attack from worsening. Your child may need to talk to the teacher and go to the school nurse if symptoms begin during school.

It is worthwhile for you to talk with your child about the various symptoms that occur with their migraines. Try to identify the earliest signs. Some children experience a prodromal stage before a migraine reaches its peak. Symptoms during the prodromal stage can include:

• Dizziness
• Stomach aches
• Photophobia (sensitivity to light)
• Phonophobia (sensitivity to sound)
• Osmophobia (sensitivity to smell)
• Irritability
• Sleepiness

Over time, your child can learn to recognize these and seek treatment as early as possible.

Avoiding Triggers

Medications can only do so much. Identifying and avoiding migraine triggers is an essential part of a complete migraine treatment and prevention plan.

Migraines can be triggered by a number of factors, including stress and lack of sleep. As a parent, you can work with your child to figure out if any of these factors cause your child's migraines—and how to avoid them.

Paying attention to these migraine triggers can often alleviate the need for medication in the first place. Common triggers include:

• Lack of sleep
• Skipping meals
• Stress and anxiety
• Excessive computer and electronic use
• Caffeine intake
• Dietary triggers

Unless you find a specific dietary migraine trigger, putting your child on a restrictive diet is not a good idea and should not be done without consulting with their doctor. Kids can be pretty picky about food, and unnecessarily eliminating foods "just in case" won't prevent migraines.

A Word From Verywell

Be sure to discuss your child's symptoms with their doctor before concluding that they are migraines. Some children have allergies, anxiety, or even medical problems that can manifest in the same way as migraines. Once migraines are diagnosed, you can focus on managing and preventing the episodes.

Talk to your pediatrician if your child's migraines worsen, change, or if your child develops new symptoms.