By Genevra Pittman
Reuters
A drug-free placebo pill prevents migraines in kids and teens just as well as most headache medicines, according to a new review of past evidence.

Researchers found only two drugs known to help migraine-plagued adults reduced the frequency of kids' headaches better than a placebo. And even in those cases, the effect was small - a difference of less than one headache per month compared to the dummy pills.

"Parents should be aware that our medication choices aren't as good as they should be," said Dr. Jennifer Bickel, a neurologist and headache specialist at Children's Mercy Hospitals and Clinics in Kansas City, Missouri.

Bickel, who wasn't involved in the new research, said no drugs have been rigorously tested and approved for preventing migraines in kids, so doctors have to rely on headache drugs made for adults.

Those medicines, she added, are "not a miracle cure."

For cases when medication may not be enough, Bickel told Reuters Health, parents may want to look into relaxation techniques - such as meditation - for kids with chronic headaches.

According to data from the Cleveland Clinic, about 2 percent of young children and 7 to 10 percent of older kids and teenagers up to age 15 get migraines.

In their review, Dr. Jeffrey Jackson from the Medical College of Wisconsin in Milwaukee and his colleagues looked at 21 trials comparing headache drugs to each other or to placebos. They found only topiramate (marketed as Topamax) and trazodone (Oleptro and Desyrel) significantly reduced the frequency of headaches in kids and teens who got regular migraines.

Other adult headache prevention medicines, including flunarizine, propranolol and valproate, were of no help.

"All the drugs in our analysis have been found effective in adults with migraine headaches, but few were beneficial among children," Jackson's team wrote.

"This suggests there may be something different about pediatric migraines or that the response to treatment differs between children and adults."

Bickel said there is the least research on the one percent of kids who are most severely affected by migraines - those with chronic daily headaches. For those youth, "we don't have any evidence to suggest that the medications are enough," she added.

Power of placebo?

In the new analysis, published Monday in JAMA Pediatrics, placebo pills alone led to a drop in kids' headache frequency from between five and six headaches per month to three per month.

That may have to do with the effect of seeing a doctor and being reassured the pain isn't due to anything serious, Bickel said.

According to a report from the U.S. Food and Drug Administration published in the same journal issue, two drugs - almotriptan malate (Axert) and rizatriptan benzoate (Maxalt) - are approved to treat (but not prevent) headaches in kids and teens.

In a review of evidence provided to the FDA, Dr. William Rodriguez and his colleagues also found kids tended to get better after treatment with a placebo more often than adults - possibly related to their headaches lasting less time anyway.

For kids who get headaches once a week or less, Bickel said the pain can be treated with over the counter painkillers, or even just waited out in a quiet place.

By Karen Rowan
MyHealthNewsDaily

Children with migraine headaches may do worse in school than other students, a new study suggests.

Kids in the study who suffered episodic migraines (i.e., migraines occurring fewer than 14 days each month) were 1.3 times more likely perform below average in school, compared to kids who didn't have any type of headache. And kids with chronic migraines (i.e., migraines occurring 15 or more days each month) were 1.6 times more likely to perform below average in school, compared to kids without headaches.

"For years, we've had few studies that have linked the symptoms of migraines to the burden on children and families," said Dr. Lenora Lehwald, a neurologist at Nationwide Children's Hospital in Columbus, Ohio. Studies such as this one may help get "buy-in" from schools in helping kids who suffer migraines get prompt treatment, she said.

"Children with migraines need immediate treatment, or their meds won't work as well," said Lehwald, who was not involved in the study. "Having the school understand the significance of the headache helps move the treatment more quickly along," she said.

Kids with migraines often have to deal not only with their physical pain, but also the frustration of adults not understanding the condition, Lehwald said. "This is not a malingering child, this is a pathology that needs treatment."

Migraines and school
In the study, researchers looked at 5,700 children in Brazil, between ages 5 and 12, collecting data by interviewing teachers and parents. The study was conducted by researchers at Merck & Co., a pharmaceutical company, and is published today (Oct. 29) in the journal Neurology.

Of the 1,108 children in the study who had no headaches, 257 (23 percent) were rated by their teachers as performing below average in school. By contrast, of the 486 children with episodic migraines, 158 (33 percent) were rated as performing below average, and 13 of the 35 (37 percent) of children with chronic migraines were rated as such.

In addition, the study showed that kids with migraines were also more likely to have missed at least one day of school in the last six months, and more likely to have left school before the end of the school day, as compared with children who get tension headaches rather than migraines.

In her experience treating children who suffer migraines, Lehwald said, she has met some patients who feel the school doesn’t understand how physically debilitating their symptoms can be. "The school may think the kid is making up the symptoms. Kids feel very discouraged, and like nobody understands."

Such feelings may further affect children's moods and self-esteem, and make them even less likely to report their symptoms, she said.

What parents can do
Parents can also help their help children who have migraines do better in school by keeping them on regular schedules, Lehwald said. For children with migraines, "having a very even-keel lifestyle puts them less at risk of having a migraine. Staying hydrated, not skipping meals, adhering to a good sleep schedule," can all help, she said. "They need a predictable 24-hour schedule."

Parents can also model for their children the type of attention they need to give to their migraines as soon as one starts. A migraine “can be a really debilitating experience if not treated as an emergency. Parents can help a child learn that, too."

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