1. Introduction 2. General methods 3. Acute therapy 4. Preventative therapy 5. Biobehavioral therapy 6. Conclusion 7. Expert opinion Review Treating pediatric migraine: an expert opinion Hope L O’Brien † , Marielle A Kabbouche & Andrew D Hershey † Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Introduction: Headaches are common in children and adolescents and migraine affects almost 8% of this population. As revisions are made to the ICHD-II criteria to include additional characteristics of pediatric migraine, the diagnosis of migraine is expected to increase. Therefore, it is important to understand and apply successful treatment in acute migraine. Patients and families should be educated about the options for migraine treatment that includes both pharmacologic and conservative behavioral techniques in managing headaches. Areas covered: This review examines the studies that have been performed in pediatric patients, in addition to exploring the treatment options commonly used in pediatrics and adolescents for migraine and their rationale for use. Expert opinion: For the acute treatment of migraine, we recommend the use of ibuprofen or acetaminophen for mild, moderate or severe headache. For moderate to severe headache, or for headaches that fail to respond to over- the-counter medications, we recommend the use of a triptan or combination NSAID/triptan therapy. For preventative treament of migraine, cyprohepta- dine should be reserved for younger children unable to swallow tablets while amitriptyline is preferred due to its once daily dosing and minimal side effects. Topiramate and divalproate are considerable options depending on patient co-morbid profile and preference. Keywords: acute headache treatment, non-pharmacological treatment, nutraceuticals in pediatrics, pediatric headache, pediatric migraine, prophylactic headache treatment Expert Opin. Pharmacother. [Early Online] 1. Introduction Headaches are common in children and adolescents and migraine affects almost 8% of this population [1]. It is becoming more recognized as a common condition among this population, yet it remains undertreated. As revisions are made to the ICHD-II (2nd Edition of The International Headache Classification) criteria to include additional characteristics of pediatric migraine, the diagnosis of migraine is expected to increase. Therefore, it is important to understand and apply successful treatment in acute migraine. Lack of evidence or insufficient clinical trials focused on pediatric migraine has been a barrier to adequate management. This lack of data is due to multiple factors. Pediatric studies are known to have high placebo rates compared with those seen in adults making results difficult to interpret. Many of the studies did not consider the differences in childhood migraine as depicted by the revised ICHD-II criteria in identifying migraine patients. Con- founding factors such as non-pharmacological remedies suggested by parents or family members such as sleep or eating a meal can also impact the study. Not to mention consideration of the ethics involved in giving medications to a child with the potential of significant harmful risks. Subsequently, clinicians relied either on over-the-counter simple analgesics that have been proven safe and effective in pediatric migraine or have recommended treatment based on adult data. Limited medications that have been Food and Drug Administration (FDA)-approved for 10.1517/14656566.2012.677434 © 2012 Informa UK, Ltd. ISSN 1465-6566 959 All rights reserved: reproduction in whole or in part not permitted Expert Opin. Pharmacother. Downloaded from informahealthcare.com by Childrens Hospital on 04/17/12 For personal use only.