Migraines in Children: How Well Do Meds Work?

Few things are as difficult as seeing your child in pain. I remember when Keegan broke his leg and how much it hurt me knowing he hurt.

Headaches in children can be just as unbearable for a parent, but with the added concern of whether something more ominous is causing the headaches. While misguided, most parents will present to his or her pediatrician for evaluation and some type of answer. This usually prompts imaging of the brain despite the absence of red flags.  MRI if you are lucky, CT scans if your pediatrician wouldn’t recommend a medical journal if he or she got whacked upside the head with it.

Side note: In the absence of red flags, advanced imaging is not recommended.  Even when imaging should be done, it should be an MRI (with the single exception of looking for a subarachnoid hemorrhage, which is much more likely to occur in the elderly population). The radiation exposure with a CT scan is extremely high and has been linked to some 29,000 cancers per year.

So everything comes back normal, but your little baby is still having nightmare headaches. It’s nice to know there is nothing “real” going on, but this doesn’t take care of the migraine headaches. Your pediatrician’s only answer at this point is medication.

It is unfortunate, but a referral to a chiropractor is rarely undertaken before the medication. Many of the kids who come into our office for treatment of his or her headaches have already tried everything including medications. Most often we are able to help in a very short period of time, although there have been cases over the years that treatment in our office was not able to help and we just became one more therapy in a long list of failed attempts.

Anecdotally, I can tell you that we do extremely well with headaches. However, our comprehensive approach (manipulation, soft tissue work, diet, stress management) to migraines in children has not been studied in any type of clinical trial that I’m aware of, so maybe I could understand a pediatrician’s reluctance to refer out to a chiropractor. After all, we don’t want to subject our children to anything that has no research to back it up, right?

Which, of course, brings us to this particular study.  Basically, researchers looked across multiple studies to see which medications have been shown to be effective for the treatment of migraines in children. Here’s what they found:

  • Topiramate (Topamax) led to 0.7 less headache days per month.
  • Trazodone was slightly less effective at 0.6 less headache days per month.
  • Drugs with no benefit included clonidine, flunarizine, pizotifen, propranolol, and valproate (Depakote).
  • A single trial of fluoxetine for chronic daily headaches found it ineffective.
  • However, kids given placebo experienced an almost 50% drop in headache days (down 2.7 days / month).

Basically, the evidence sucks for the use of most medications for treatment of migraines in children.

Placebo, on the other hand, plays a far, far stronger role in slashing headache frequency in the children in these studies. Something to consider strongly should your pediatrician recommend medications (with a long list of side effects) to help control migraines in children.

It also brings us back to the use of a comprehensive chiropractic approach to the treatment of headaches in children. Our care is extremely safe when compared to any medication, and, at least according to this review, it certainly couldn’t be any less effective!

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.