Migraine is a neurological (nervous system) disease that causes moderate to severe headaches, sometimes with other symptoms like nausea, vomiting, and sensitivity to light and sound. At least 1 in 10 children have migraine disease.
Preventive medicines
Preventive medicines are used to reduce how many and how serious migraine attacks are in children. They help make the brain less sensitive to pain, which can prevent some migraine attacks and make them less painful. Preventive medicines for migraine include:
- calcium channel blockers
- antihistamines
- anticonvulsants
- antidepressants
- beta-blockers
- anti-CGRP pathway medicines (gepants and monoclonal antibodies)
- vitamins, herbs, and minerals
Your child's healthcare provider might recommend preventive medicines if your child has more than 4 migraine attacks per month. Preventive medicine can help lower the number of migraine attacks your child gets by half or more.
If your child is taking preventive medicine, they usually need to take it every day without skipping a dose or as directed by their healthcare provider or pharmacist. Preventive medicines take about 12 weeks to start working. Talk to your child's healthcare provider if the medicine isn’t working after 12 weeks.
Your child's healthcare provider can help you choose the best medicine for your child. Tell them if your child has any other health concerns like problems with sleep, depression, anxiety, or seizures.
Most children don’t need preventive medicine for the rest of their lives. They usually take it for about 12 months and stop once they have fewer migraine attacks.
Preventive medicines are generally used in low doses to prevent migraine attacks, so their side effects tend to be mild.
Calcium channel blockers (CCBs)
CCBs, like flunarizine, work well for migraine in children. CCBs change how blood vessels in the head react to a migraine attack and block chemicals that cause a migraine attack. Side effects include feeling tired, sleepy, or depressed.
Antihistamines
Antihistamines help with allergy symptoms. Cyproheptadine is an antihistamine. It’s sometimes used for children under 12 years old who have migraine attacks often. Side effects include feeling sleepy and hungrier than usual.
Anticonvulsants
Anticonvulsants are medicines for seizures and epilepsy. Topiramate (Topomax) is an anticonvulsant that works well to prevent migraine attacks. It works best in children between 12 and 17 years old.
Side effects of topiramate include:
- feeling tired
- mood changes
- taste changes
- kidney stones
- trouble concentrating
- feeling numb and tingly
- sweating less
- feeling less hungry than usual
- losing weight
Research shows that the anticonvulsants valproic acid (Epival) and levetiracetam (Keppra) can also work well for youth with migraine.
Side effects of valproic acid can include:
- nausea (feeling sick to your stomach)
- feeling tired
- losing hair
- bruising
- gaining weight
If your child has nausea, it may help to give them a snack with this medicine.
Side effects of levetiracetam include a risk of behavioural or psychiatric symptoms, like irritability or strong mood swings. This happens in about 10 to 15 out of 100 people who use levetiracetam.
Antidepressants
Antidepressants are medicines that treat depression. Some antidepressants like amitriptyline and nortriptyline also block chemicals in the brain to prevent migraine attacks.
Side effects include:
- dry mouth
- feeling sleepy
- sudden weight gain
- feeling dizzy when changing positions
- sweating or flushing of the skin
- nausea (if your child has nausea, it may help to give them a snack with this medicine)
Beta-blockers
Beta-blockers, like propranolol, are normally used to lower blood pressure but they also block chemicals in the brain that can help to prevent migraine attacks.
Side effects include:
- nausea
- vomiting
- diarrhea (loose stool)
- not feeling hungry
- belly pain
Some research shows that beta-blockers may affect the airways. Tell your healthcare provider if your child has a history of asthma.
Anti-CGRP pathway medicines
Gepants and monoclonal antibodies are 2 newer types of preventive medicines specifically for migraine that block the calcitonin gene-related peptide (CGRP) pathway.
Preventive gepants include:
- atogepant (Qulipta), taken every day
- rimegepant (Nurtec), taken every second day
Preventive anti-CGRP monoclonal antibodies include:
- eptinezumab (Vyepti), given by intravenous (I.V.)
- erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality), given by injection 1 time per month. Fremanezumab can also be given 1 time every 3 months.
Side effects can include:
- a reaction where your child gets the injection (like pain, redness, or irritation)
- nausea
- higher risk of minor infections like colds
- constipation
- risk of high blood pressure
Most of these anti-CGRP pathway medicines are still being studied in children under 18 years of age and so are not yet approved for youth by Health Canada.
Vitamins, herbs, and minerals
There isn’t enough research to know if vitamins, herbs, and minerals can help to prevent migraine attacks. But some research shows the following may help:
Magnesium supplements. Magnesium supplements sometimes cause abdominal symptoms (like abdominal pain and indigestion) and diarrhea.
Coenzyme Q10 supplements. They typically don’t cause any side effects but can increase burping.
What migraine medicine will work for my child?
Every child is different. It might take time to find the best medicine for your child. Your child might need to try a different type or dose of medicine to manage their migraine disease.
Encourage your child to ask questions about their migraine disease. Ask your healthcare provider to help you and your child make a plan to manage their migraine disease.
