Migraines in Kids: How Can We Best Prevent Them?

Migraines in Kids: How Can We Best Prevent Them?

Migraines in kids. How can we best prevent them? That is a question we hoped to answer when began a study that was published in the New England Journal of Medicine this week.

In particular, we wanted to know which preventive medications are the most effective at preventing migraines in kids. With 10% of children under the age of 12 and up to 25% of girls by the time they turn 18 getting migraines, we think it is important information to have.

The Study’s Results

Surprisingly, our study results found that the commonly prescribed preventive medications for migraines in kids – amitriptyline and topiramate – were just as effective as a sugar pill, or placebo.

I am certain that this is going to raise many questions with both parents and physicians alike. The good news is that we know that kids’ migraines can get better with the multidisciplinary therapies applied in this study and the expectation of response (read more about that below) – in addition to the medications. In fact, our study found that those receiving:

  • A sugar pill had a 61% reduction in migraines
  • Amitriptyline had a 52% percent reduction in migraines
  • Topiramate had a 55% reduction in migraines

Neither the two medications nor the sugar pill’s results were statistically different from each other. We got kids with migraines better, but it doesn’t necessarily mean they need to take a medication for that to happen.

What’s Interesting About the Results

These two aspects – not necessarily medications – appear to have played a more important role in getting kids better:

  • The expectation of a response
  • Non-pharmacologic (drug) therapies

The placebo effect, or the expectation of a response after receiving a sugar pill, was 61% effective at reducing migraines. Patients thought that they would get better, so they did. This study tells us that we need to look further into how we can help kids achieve this without giving them medications (or thinking that they’re being given medications).

The Role of Non-Pharmacologic (Drug) Therapies

The other interesting aspect was the non-pharmacologic therapies utilized with all 328 patients across 31 sites nationally. Every patient received acute therapy, healthy habit discussions and help with adherence. Because medications and placebo were equally effective, these other therapies probably played a large role in getting kids’ migraines better.

When we embarked upon this study, we hoped to find a clearer picture for preventing migraines in kids. What we found is that it might not be as simple as prescribing a medication. Our research shows that a more holistic approach incorporating multiple therapies may be the best at preventing them.

So to answer the question, how can we best prevent migraines in kids? With this research, we now know that it’s not a simple answer of which medication to use. It’s more complex of an answer and we plan to study this further to determine which therapies work the best to prevent migraines in kids.

Editor’s note: Andrew Hershey, MD, PhD, pediatric neurologist and co-director of the Headache Center at Cincinnati Children’s, was a co-author of this study.

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Scott Powers, PhD

About the Author: Scott Powers, PhD

Scott Powers, PhD, is a pediatric psychologist in Behavioral Medicine and Clinical Psychology and the co-director of the Headache Center at Cincinnati Children’s.

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  1. Perhaps this is the reason that NO preventative meds have worked on my son. Maybe this is the reason I am once again at the ER with him as he receives a "migraine cocktail." Perhaps some kids--like mine--need a more aggressive approach medically.
  2. Darla Frey October 31, 01:35
    We adopted our son . He constantly has mmigraine . His biological mother has mmigraine and then has a seizures . Gavin is 9 and hasn't had any seizures . However, the other day he was at school and a migraine hit him . The teacher said he started shaking and about passed out I brought him home and he slept the rest of the day . Is migraines hereditary? We've tried medication . Nothing seems to work . Thanks! Darla
    • Scott Powers, PhD Author November 01, 07:18
      Hi Darla, Migraine is certainly a hereditary disease. About 85% of individuals with migraine have a known relative who also has them (mom, dad, grandparents, siblings). Excellent studies have documented the genetic basis of migraine and the familial inheritance of the condition. Typically 9 year olds with migraine can get a lot better. Our Center is one option for care, as is looking at the Migraine Research Foundation as well as the American Headache Society websites for locating pediatric headache specialists around the country.
  3. Ideoform December 07, 00:06
    My son gets migraines. He got tired of all the side effects of most of the medications. Now when he gets a migraine he takes vitamin B2 and Butterbur. He also got good results from acupuncture. For prevention, we did an elimination diet and found out that he reacts very strongly to aspartame, and mold in grains and foods that tend to get moldy during processing and storage. There are several food additives that can cause problems. Food colorings, especially yellow dye, cause migraines and hyperactivity, and anxiety. We ended up switching to organic food since it got really tiresome searching all the labels for the addditives he reacts to.
  4. My wife & I have a 17 year old daughter that had a sudden headache develop on June 6, 2016. This headache is continuous with debilitating spikes and does not responded to any medication. We have seen two different neurologist and have had all the test (EEG, MRI, MRA, Spinal Tab, Eye tests, ENT tests, etc..), all of which come back normal (thankful). We have tried acupuncture and PT with dry needling. We are now on a sugar free diet (no carbs, no fruits other than berries, no root vegetables like potatoes). We recently spoke to a family with a 12 year old daughter with same condition and they had success at another hospital's Pediatric Pain Rehabilitation program, which appears to pursue non-pharmacologic therapies. Does Cincinnati Children's have a similar type program? What success do you have with continuous headaches? Our neurologist here in Atlanta mentioned you. We are out of options and need help.
    • Rachel Camper
      Rachel Camper February 07, 12:32
      We do have an inpatient rehabilitation program. It might be best for you to reach out to our Headache Center directly, that way we can learn a little more about your daughter's situation and be able to guide you on potential next steps to take. We can be reached by calling 513-636-4222 or emailing neurodesk@cchmc.org.
  5. My kids all get migraines but my daughter's presented like a stroke with her right side going numb and then another one that she walked around like "the lights were on but no one was home", babbling, and pulling on her lips. After multiple trips to ED and extensive testing we discovered that all of my children and I have a gene mutation (CACNA1A) which can cause hemipalegic migraines, episodic ataxia and/or spinocerebellar ataxia. Sometimes a migraine is a migraine and sometimes it is something much more. CCHMC is wonderful and they will work with you until they find a treatment that works for you. The process can be frustrating and lengthy but if you keep a diary and record them when they are in the middle of the attack, together you will find a solution.