What is new in migraine management in children and young people?

• Published in: Archives of disease in childhood Vol. 107; no. 12; pp. 1067 - 1072
• Main Authors: Loh, Ne Ron, Whitehouse, William P, Howells, Rachel
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.12.2022; BMJ Publishing Group LTD
• Subjects: Adolescent; adolescent health; Adult; Amitriptyline; Angiotensin; Antagonists; Behavior modification; Botulinum toxin; Calcitonin; Calcitonin gene-related peptide; Child; Children; Diet; Drug dosages; Evidence; Functional foods & nutraceuticals; Headache; Headaches; Humans; Infantile colic; Magnesium; Melatonin; Migraine; Migraine Disorders - drug therapy; Migraine Disorders - prevention & control; neurology; Neuromodulation; Obesity; Overweight; paediatrics; pain; Pediatrics; Peptides; Peripheral nerves; Pharmaceutical Preparations; Pharmaceuticals; Prevention; Propranolol; Quality of life; Review; Riboflavin; Sleep; Teenagers; therapeutics; Topiramate; Toxins; Treatment Outcome; Trigeminal nerve; Vagus nerve; Vitamin B; Vitamin D; Weight control; paediatrics; pain; therapeutics; neurology; adolescent health
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-322373

For this narrative review, we found recent publications on the use and effectiveness of old therapies including nutraceuticals, such as riboflavin, vitamin D, magnesium, melatonin and talking therapies. Recent large trials of established conventional pharmaceuticals such as propranolol, pizotifen, topiramate and amitriptyline for childhood migraine have failed, but the use of a quasi-placebo in future trials could help. We reviewed the evidence for angiotensin antagonists including candesartan in adults, but found a lack of evidence for their use in children. There have been new developments in pharmaceuticals recently, including a more selective 5-HT1F agonist, lasmiditan, an effective acute treatment with no vasoconstrictor activity in adults, currently being tested in children. Also, a number of new calcitonin gene-related peptide (CGRP) antibodies and antagonists, with proven efficacy in acute treatment and/or prevention of migraine in adults, are undergoing trials in children. Peripheral nerve blocks and botulinum toxin are gaining popularity in adult practice, but we really need more good quality evidence for their effectiveness in children. Finally, electroceuticals, that is, therapeutic electric devices, are now marketed for acute and or preventative treatment, including an external trigeminal nerve stimulator (e-TNS), a non-invasive vagal nerve stimulator (nVNS), a single-pulse transcranial magnetic stimulator (sTMS) and a remote electrical neuromodulation device (REN). At the moment, evidence for their effectiveness in children is still lacking. So, there has been much progress, but mostly for adults. We are in urgent need of more migraine trials in children.