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  • Review Article
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Paediatric migraine: evidence-based management and future directions

Nature Reviews Neurology volume 14, pages 515–527 (2018)Cite this article

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Abstract

Migraine is prevalent in children and adolescents and constitutes an important cause of disability in this population. Early, effective treatment of paediatric migraine is likely to result in improved outcomes. Findings from the past few years suggest that a biopsychosocial approach that uses interdisciplinary multimodal care is most effective for treatment of migraine in the paediatric population. Key elements of this management include effective and timely acute pharmacological interventions (such as NSAIDs and/or triptans), education of patients regarding self-management techniques, and psychological interventions such as biofeedback, relaxation and cognitive–behavioural therapy. The efficacy of current pharmacological or nutraceutical interventions for migraine prevention in children and adolescents is unclear, although reported placebo response patterns suggest that the effect of pill-taking behaviour is positive. As such, clinicians can consider adding a preventive intervention that involves a daily pill-taking behaviour to evidence-based non-pharmacological first-line preventive interventions (such as cognitive–behavioural therapy). More rigorous research is needed to delineate the role of pharmacological and nutraceutical interventions, the mechanisms of the clinically relevant placebo response, and interventions that enhance this response for migraine prevention in this population. Given the prevalence of migraine, cost-effective and efficacious strategies are needed for the large-scale delivery of interdisciplinary multimodal paediatric migraine care.

Key points

  • Paediatric migraine is very common, affecting ~8% of children and adolescents, and causes a substantial amount of disability in this population.

  • Establishment of a diagnosis and treatment of migraine early in the disease course can prevent disease progression.

  • The goals of paediatric migraine treatment are to reduce migraine-associated disability, improve pain-coping strategies, improve health-related quality of life and reduce the risk of migraine chronification.

  • Evidence-based paediatric migraine treatment involves consistently effective, appropriately dosed acute interventions and interdisciplinary multimodal preventive care, including self-management, lifestyle interventions and tailored psychological, pharmacological and/or complementary and alternative interventions.

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Fig. 1: Incidence of migraine by age.
Fig. 2: Goals of paediatric migraine treatment.
Fig. 3: Dimensions of preventive treatment for paediatric migraine.
Fig. 4: Proposed evidence-based treatment approach to paediatric migraine.

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Nature Reviews Neurology thanks A. Verotti, P. Parisi and the other anonymous reviewer(s) for their contribution to the peer review of this work.

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  1. Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Serena L. Orr, Marielle A. Kabbouche, Hope L. O’Brien, Joanne Kacperski & Andrew D. Hershey

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Marielle A. Kabbouche, Hope L. O’Brien, Joanne Kacperski, Scott W. Powers & Andrew D. Hershey

  3. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Scott W. Powers

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S.L.O. wrote the article. S.L.O., S.W.P. and A.D.H. researched data for the article. All authors contributed substantially to discussion of content and review of the manuscript before submission.

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Orr, S.L., Kabbouche, M.A., O’Brien, H.L. et al. Paediatric migraine: evidence-based management and future directions. Nat Rev Neurol 14, 515–527 (2018). https://doi.org/10.1038/s41582-018-0042-7

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