Treatment of Migraine with Brainstem Aura in Children and Adolescents Younger than 18

Managing migraine with brainstem aura in patients under 18 requires age-appropriate strategies. Acute treatment considerations differ between younger children and adolescents, and response to initial analgesic therapy guides subsequent decisions.

Clinical Scenario

          This protocol applies to patients younger than 18 years of age presenting with migraine with brainstem aura. The pediatric and adolescent age group carries specific treatment implications, including which therapies are suitable and at what age.
        

Treatment Approach

Acute migraine attacks in children are initially managed with analgesics. In adolescents aged 12 or older who do not achieve an adequate response to analgesic therapy, a class of migraine-specific prescription agents may be appropriate as a next step.

The complete regimen — including which agents, the decision criteria, and the full clinical algorithm — is available in the structured protocol.

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References

DOI: 10.1177/2514183X1882337

Migraine attacks in children are treated with ibuprofen 10 mg/kg body weight (BW), ASA (500 mg) or paracetamol 15 mg/kg BW (second choice).
Sufficient data are available to justify the use of triptans (sumatriptan 10–20 mg as nasal spray, zolmitriptan 2.5–5 mg tablets, rizatriptan 5–10 mg tablets and almotriptan 12.5 mg tablets) in adolescents in case of inadequate response to acute therapy with analgesics.
Sumatriptan 10 mg and zolmitriptan 5 mg as nasal spray are approved for the treatment of migraine in adolescents age 12 or older.

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