Migraine in children and teenagers: Can taking medications or herbal products prevent attacks?

There is some weak evidence that some medications can prevent migraines in children and young people. However, not enough research has been done on their safety and effectiveness for them to be approved for use in children and teenagers in Germany.

Some people have occasional migraines, which can cause a lot of pain and make them feel ill. Migraine attacks last at least four hours in adults and teenagers, and at least two hours in children. But they do not happen very often. It is not yet known what exactly causes them. You can read about the signs of a migraine here.

Most children and teenagers manage their migraines with changes to their lifestyle and medications for pain relief when they need them. However, if the migraines happen so often that they interfere with daily life, or if medications for attacks do not help, then young people and their parents often try to find ways to prevent migraines.

Children and teenagers might be able to reduce migraine attacks by using different methods like changing their lifestyle, learning relaxation techniques, or techniques to better and manage migraines. You can read more about that in the research summary “Migraine in children and teenagers: Are there ways of preventing migraines without using medication?”.

These approaches are not always easy to implement, though, and they do not always work. Some children and teenagers still have more than four migraines a month. The symptoms may be very severe, preventing them from going to school and doing other activities. Preventing migraines with medications is an interesting option for them, even if that means taking medication every day.

No medications are approved yet for preventing migraines in children and teenagers

There are several medications that adults can use to prevent migraines, but this does not automatically mean that they will work for children too. Drugs can affect children’s bodies differently, and children’s migraines are different from migraines adults get. This means that the results of research on migraine drugs in adults do not necessarily apply to children and teenagers.

Not many trials have been done on the prevention of migraine attacks in young people. Therefore, the regulatory agencies have not approved any drugs for the prevention of migraines in children and teenagers yet. The European Medicines Agency (EMA) is responsible for drug approval in Europe, and the U.S. Food and Drug Administration (FDA) has this function in the United States. Some countries have approved one or another drug on their own, but most countries have not.

In Germany, no medication has been categorized as safe and effective for migraine prevention in children and teenagers, and therefore none has been approved. If a drug has not been approved for use in children and teenagers, they can only use it “off-label”. Off-label use is when a drug is used in a group of patients or for a medical condition despite not being approved for this kind of use. If your doctor prescribes a medication for off-label use, then he or she will need to inform you about it. You can read more about what off-label use of drugs means in the information: “What is ‘off-label use’?”.

Medications and herbal products

There are several types of medications that are used for migraine prevention in adults and sometimes off-label in children and teenagers too. The main agents that have been studied are:

• Antihypertensive (blood-pressure-lowering) drugs: These include calcium blockers (also called calcium-channel blockers), such as flunarizine. Another antihypertensive drug is a beta-blocker called propanolol. These drugs can cause a variety of side effects, including drowsiness, tiredness, stomach and bowel problems, and nausea.
• Herbal products and dietary supplements: These include feverfew and dietary supplements containing magnesium and vitamin B2. Herbal products can also cause side effects. You can read more about things to consider if you are taking herbal products and dietary supplements in the feature “Using dietary supplements and complementary medicines”.
• Allergy medicines (antihistamines): These drugs block allergic reactions in various ways. One drug from this group, called pizotifen, is used in some countries to prevent migraines, but it is not available in Germany.
• Antiepilepsy medicines (anticonvulsants): These drugs are sometimes used in severe migraine to prevent migraine attacks. One of these drugs is called topiramate. These drugs are usually used to treat epilepsy, a type of nervous disorder causing seizures. In Germany, anticonvulsants are not approved for preventing migraines in children and teenagers.

Research results on migraine prevention

Trials for migraine treatment in children and teenagers usually involve comparing a group of people taking a drug with another group taking a dummy treatment (placebo). This way, researchers can find out whether a drug helps for migraine. For many children and teenagers, migraines will get better over time without treatment. Without doing a trial with a comparison group who do not take the medication, we cannot know whether the medication relieved the migraine or whether it went away on its own.

Researchers systematically analyzed trials that had studied migraine prevention with medications in children and teenagers. They found 26 comparative trials that had compared 15 different medications either with a dummy treatment or with one of the other medications. Altogether, the trials included about 1,200 children and teenagers between the ages of 3 and 18. The result: the researchers concluded that there was not enough data on any drug to be able to weigh the advantages and disadvantages with certainty.

There is, however, weak evidence for three drugs that they might be able to reduce the frequency of migraine attacks: flunarizine, propanolol, and topiramate. But for these medications, too, the research did not lead to clear conclusions. There were either too few trials on one question, not enough participants in the trials, or the results were partly contradictory.

There has also been too little research on herbal medicines to know whether or not they can prevent migraines.

If your child takes a medication, then it is important to review this every few months. Because many children and teenagers grow out of their migraines, the problem may have lessened or gone away on its own, and not because of the medication. You can read more about migraines in children and teenagers in our feature “Migraines”.

Author: Institute for Quality and Efficiency in Health Care (IQWiG)

Next planned update: March 2015. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced".

© IQWiG (Institute for Quality and Efficiency in Health Care)