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Preventing Migraine Headaches

Expert Q&A

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Updated January 11, 2009

Q. I am a parent of six-year-old daughter who suffers from what I believe to be migraines, because nine years ago I was diagnosed by my doctor as having migraines too. I have taken her to her pediatrician on many occasions. Most of the time, he would recommend giving her Tylenol. This does not usually work.

He then prescribed her Tylenol with Codeine which did work either, I think mainly because it would make her go to sleep. I feel so helpless in this matter, because with her being a child, I really don't know what I should be doing. Her pediatrician also prescribed what I think he called a prophylactic medication to prevent her from getting more headaches. Is something she would need to take on a daily basis? I really do not want her on a daily medication unless it is absolutely necessary. What are your thoughts on this? She gets headaches anywhere between four to six times a month. Rachel, California

A. If you have migraines and she has typical migraine symptoms, then you are probably right that she has migraines too. Migraines are common in kids, affecting about 5% to 10% of children.

There are two main ways to treat migraine headaches. The first is to simply take something when you get a headache or feel one coming on, with the hope that it will quickly go away. This is harder to do in kids, as the common migraine treatments that adults use, like Imitrex (Sumatriptan), aren't FDA approved for use in young children. So that leaves you with just using a pain medication, like Tylenol or Motrin, when your child gets a headache.

Keep in mind that Imitrex is being used 'off-label' by more and more doctors with success these days though, since studies have shown it to be safe and effective in children.

The other way to treat migraine headaches is to try and prevent them by taking a prophylactic or preventative medication every day, even when your child doesn't have a headache. Commonly used prophylactic medications for migraines include:

The two preventative medicines most commonly used in younger children include Periactin and Elavil, since pediatricians often have more experience using them than using the other medications. A review article on Headaches in Children and Adolescents, states that 'in children younger than 10 to 12 years, cyproheptadine (Periactin), in a dosage of 2 to 8 mg at bedtime or divided twice daily, is a safe initial agent. If it fails to limit the frequency and severity of headaches in children in this age group, amitriptyline (Elavil), propranolol (Inderal), carbamazepine (Tegretol), or valproic acid (Depakene) can be used.'

Does your child need a prophylactic migraine medication?

In general, 4 to 6 migraine headaches a month would be considered a lot. And many people would want to do something, even if means taking a medication every day to prevent that many headaches.

You also have to consider how bad the headaches are though. If they are minor and she just has to rest for 10 or 15 minutes, then you might not need to do anything. On the other hand, even just one or two bad headaches a month might be enough to warrant a prophylactic medicine.

Dr. Linder, in an article on Pediatric Headache, reports that the 'use of preventive therapy should be considered if the patient is having approximately 2 or more headaches per week that are associated with disability or 3 to 4 incapacitating headaches per month.'

Another way to think about it, is do the headaches interfere with her daily routine and day to day activities? Is she missing a lot of school or other activities? If so, then a prophylactic medicine to prevent her migraines might be a good idea.

You might also keep a symptom diary to see if you can find and avoid specific triggers for her migraines. Is she getting enough sleep? Does stress seem to be a trigger? Or does she get them after eating or drinking certain things? Or after skipping meals?

Keep in mind that common foods, including many kids' favorites, that are thought to trigger migraines include:

  • Chocolate
  • Diet drinks (aspartame)
  • Cheese
  • Hot dogs and processed meats (nitrites)
  • Soda (caffeine)
  • MSG
  • Fatty foods (fatty acids)

A Pediatric Neurologist might also be helpful to manage your daughter's migraine headaches. A visit is especially important if your child's headaches aren't getting under better control after four to six months or if they are starting to get worse.



Sources:

Kliegman: Nelson Textbook of Pediatrics, 18th ed.

Lewis DW - Am Fam Physician - 15-FEB-2002; 65(4): 625-32.

Linder SL - Med Clin North Am - 01-JUL-2001; 85(4): 1037-53.

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