Pharmacists Can Help Children and Adolescents Manage Migraines

A migraine is a headache disorder characterized by recurrent painful attacks in the frontotemporal part of the brain. It can last anywhere from 2 to 72 hours and may be accompanied by vomiting, sensitivity to light and/ or sound, and nausea.¹

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Children with a migraine may complain about any of these symptoms. Migraines are common in children and become more prevalent with age; they occur in 2.5% of children younger than 7 years and in up to 28% of teenagers.²

MANAGEMENT

Given the genetic nature of migraines,² parents of patients with migraines are in a unique position to guide and teach their children how to manage this disease. While discussing therapies, pharmacists should address both parties and involve them in the care plan.

NONPHARMACOLOGIC THERAPIES

Part of nonpharmacologic treatment and prevention of migraines includes limiting common environmental or physiological stimuli.^3,4 Examples of stimuli include extreme stress, fluctuating diets, and physical overexertion.⁵ Giving open-ended prompts such as “Talk me through your sleeping habits” can help identify potential stimuli to avoid. Other nonpharmacologic therapies such as biofeedback training and cognitive behavioral therapy also have shown promise in patients with pediatric migraine.^5,6

Self-Care

Self-care can include a combination of nonpharmacologic therapies. Patients can try applying a warm or cold compress to the forehead and/or neck, resting in a dark room, and/or eating a snack.

Parents can also consider giving OTC analgesics such as acetaminophen or ibuprofen for acute pain relief (TABLE).^6,8-10

Patients experiencing migraine with aura, fever, stiff neck, incoherence, excessive thirst, reduced alertness, changes in gait, confusion, projectile vomiting, seizure, and eye or ear pain are not candidates for self-care.^6,7 Pharmacists should emphasize that these events are uncommon but should educate patients and caregivers on these signs as a precaution.

Pharmacologic Therapies

Providers may initiate prescription medication depending on migraine severity. Finding the correct regimen for migraines can be a challenging process of trial and error, and pharmacists should discuss this with patients to manage their expectations. The TABLE lists the various medications and important counseling points to mention to patients and parents.

Maintaining Logs

To adequately understand, diagnose, and prevent migraines, providers need data. Traditionally, physicians recommend patients use migraine diaries. Pharmacists should remind patients to keep a detailed log of migraine attacks and present it at visits. Sample migraine logs are available online to share with patients. Various apps such as MigraineManager can also help patients track migraine attacks, accurately document data, and present them to providers at appointments.^8,9

CONCLUSION

According to 2015 study data, up to 18% of pediatric patients in the emergency department are admitted because of migraine problems^.10 Working with patients or parents to manage migraines and directing them to seek medical attention appropriately could avoid a serious event that brings them to the emergency department.

About the Author

Sumoda Achar is a 2024 PharmD/MBA candidate

at the University of Connecticut School of Pharmacy

in Storrs.

References

1. Olesen J, Steiner TJ, Bendtsen L, et al; Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders. 3rd ed. 2017. Accessed September 21, 2023. https://ihs-headache.org/wp-content/uploads/2020/05/ICHD-3-Pocket-version.pdf
2. Migraines in children. Cleveland Clinic. Updated July 24, 2023. Accessed September 28, 2023. https://my.clevelandclinic.org/health/diseases/9637-migraines-in-children-and-adolescents
3. Pediatric migraines. Children’s National. Accessed September 28, 2023. https://www.childrensnational.org/get-care/health-library/migraines
4. Haghdoost F, Togha M. Migraine management: non-pharmacological points for patients and health care professionals. Open Med (Wars). 2022;17(1):1869-1882. doi:10.1515/med-2022-0598
5. Yamanaka G, Morichi S, Suzuki S, et al. A review on the triggers of pediatric migraine with the aim of improving headache education. J Clin Med. 2020;9(11):3717. doi:10.3390/jcm9113717
6. Headaches in children. Mayo Clinic. August 6, 2021. Accessed September 28, 2023. https://www.mayoclinic.org/diseases-conditions/headaches-in-children/diagnosis-treatment/drc-20352104
7. Understanding pediatric migraine. American Migraine Foundation. March 15, 2018. Accessed September 28, 2023. https://americanmigrainefoundation.org/resource-library/pediatric-migraine/#:~:text=Pediatric%20migraine%20symptoms&text=In%20addition%2C%20while%20adults%20typically
8. Hommel KA, Carmody J, Hershey AD, et al. Digital therapeutic self-management intervention in adolescents with migraine: feasibility and preliminary efficacy of “Migraine Manager”. Headache. 2020;60(6):1103-1110. doi:10.1111/head.13805
9. Keeping a headache diary. The Migraine Trust. Accessed September 28, 2023. https://migrainetrust.org/live-with-migraine/self-management/keeping-a-migraine-diary/
10. O’Brien HL, Kabbouche MA, Kacperski J, Hershey AD. Treatment of pediatric migraine. Curr Treat Options Neurol. 2015;17(1):326. doi:10.1007/s11940-014-0326-1