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What is new in migraine management in children and young people?
  1. Ne Ron Loh1,2,
  2. William P Whitehouse3,
  3. Rachel Howells4
  1. 1Paediatrics, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
  2. 2Paediatrics, Noah's Ark Children's Hospital for Wales, Cardiff, UK
  3. 3School of Medicine, University of Nottingham, Nottingham, UK
  4. 4Royal Devon and Exeter NHS Trust, Children & Young People, Exeter, UK
  1. Correspondence to Dr William P Whitehouse, School of Medicine, University of Nottingham, Nottingham, UK; william.whitehouse{at}nottingham.ac.uk

Abstract

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.

  • adolescent health
  • neurology
  • paediatrics
  • pain
  • therapeutics

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Footnotes

  • Correction notice This article has been updated since it was first published. In table 1, the dosage information for vitamin D has been removed.

  • Contributors NRL, WPW and RH each undertook a literature review and wrote the fist draft of electroceuticals and nerve blocks; pharmaceuticals; and nutraceuticals sections, respectively. WPW and NRL produced the figure. WPW produced the abstract. All authors reviewed and edited the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Dr NRL has no competing interests other than having been given 'Cefaly' devices for pilot use (ICMEJ section 12). Dr WPW has no competing interests other than holding the position of chair of the Children’s Headache Network which is a Special Interest Group of the British Paediatric Neurology Association, a registered charity (ICMEJ section 10). Dr RH has no competing interests.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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