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HeadWay, Issue #180 Migraine in Children and Teens - Where are we at?
August 21, 2019

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In this issue:

Migraine in Children and Teens - Where are we at?

Say what?! Biofeedback

Migraine in Children and Teens - Where are we at?

As the American Academy of Neurology and the American Headache Society update their guidelines on migraine treatment for children and teens, many questions remain.

The guidelines are an update of the previous guidelines which were published in 2004.

Progress in drug treatments for children is slow for a number of reasons. First, researchers are wisely reluctant to test drugs on children, and so much of the evidence we have for adults simply doesn't exist for children and teens. Also, the placebo effect in children is very high - meaning that few drugs are consistently more helpful than a placebo.

So those looking for great advances in these types of treatments are likely to be disappointed.

For example, in 2004 researchers did not find enough evidence to recommend amitriptyline. In the new guidelines, amitriptyline is still not considered effective alone, but does seem be be effective along with cognitive behavioral therapy (CBT), but doctors are warned that it may also cause suicidal thoughts in some cases. Topiramate and cinnarizine are in the "probably effective" treatments category. Not overly inspiring.

Well-known medications such as ibuprofen, acetaminophen/paracetamol and triptans may be helpful. But there is not a lot of news on newer treatments. Botox is not showing strong evidence at this point, and the CGRP class of drugs is really only starting the testing phase when it comes to children and teens.

The bottom line may seem like bad news, but it's really not. While most drug treatments simply don't have evidence behind them for children and teens, alternative treatments are actually very helpful.

The reality may be the same for adults, but even more powerful with the younger crowd. Hydration, a better diet, exercise - we need to stop considering these as "if all else fails" treatments. They have a better effect on long term health, and are often much more powerful than drugs.

Other treatments include biofeedback, an excellent but sadly lesser-known treatment. Biofeedback is under the category of CBT, which also includes promoting changes in thinking and attitude, and relaxation/stress reduction techniques.

To be frank, I started this article with a bit of discouragement. Progress on child and teen migraine is slow - probably slower than it should be. Maybe even some parents are slow to get serious about migraine in their children, basing their decisions on an out-dated understanding of migraine.

However, the truth is that a greater focus on lifestyle and non-drug treatments is where a lot of research is going, and should go. These types of solutions may not seem as "simple" as drug solutions, but they may actually do a lot more to fight migraine. And that's what we want, isn't it?

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