Treating migraine in teenagers

OBJECTIVE: To review the management of migraine in adolescent patients. METHODS: Literature review in the context of 2 clinical cases. RESULTS: Migraine is common in adolescents and can affect school and social functioning. Management options include lifestyle modifications and acute and preventative therapies. First-line medications for migraine in the adolescent population are over-the-counter medications, including ibuprofen, acetaminophen, and naproxen. Studies of efficacy of triptans in the treatment of pediatric migraine have been limited and results conflicting, largely due to high placebo response rates. Several classes of medications are commonly used for migraine prevention, including antidepressants and antiepileptics. Currently, topiramate is the only medication approved for prevention of migraine in patients 12 years and older. Biobehavioral treatments such as relaxation training, biofeedback, and cognitive behavioral therapy have been evaluated in randomized controlled trials and found to be efficacious. CONCLUSION: Approach to management of migraine in adolescents should be multifactorial with attention to an aggressive acute treatment regimen, preventive medications when indicated, and biobehavioral management.