Adolescent Migraine: Treatable
This report was reviewed for medical and scientific accuracy by Robert W. Gilbert, MD , Peachtree Neurological Clinic, Atlanta, Georgia.
Although much less is known about adolescent migraine than adult migraine, studies presented at the recent meeting of the American Headache Society shed light on the disorder. One study described characteristics of adolescent migraine, and other studies showed that adolescent migraine can be safely and effectively treated with triptan medications.
The study that characterized adolescent migraine included 1,932 adolescents who participated in eight different headache trials. The mean age of adolescents with migraine was 14.1 years and half of all adolescents with migraine were female; thus, the male to female ratio in this study was one to one. This is in contrast to adult migraine sufferers, in which females outnumber males by three or four to one. More than two-thirds of the study population suffered from migraine without aura, similar to adults. Interestingly, adolescent migraine attacks occurred most commonly on Monday and least commonly on Saturday. "This could be attributed to school-related pressures," said Paul Winner, MD, Palm Beach Neurological Group, Florida.
In his study, 60 percent of adolescents with migraine had nausea, 74 percent had pulsatory pain, 80 percent had photophobia/phonophobia (extreme sensitivity to light and sound), and 88 percent had headache pain aggravated by activity. "Patients with adolescent migraine are disabled, just like adults," he said.
Other data presented by Dr. Winner showed that adolescent migraine can be effectively treated with a triptan, similar to results in adults, although adolescents are less-well studied. Analysis of adolescents who participated in trials of the nasal spray formulation of sumatriptan (Imitrex®) was superior to placebo in achieving pain-free status at two hours (a study endpoint used to show efficacy of migraine drugs). Moreover, the nasal spray was well-tolerated by the adolescents, with few side effects.
Other studies of sumatriptan tablets (25 mg, 50 mg, and 100 mg) showed that the tablets were as effective in adolescents as in adults in achieving relief of pain and freedom from pain at two hours. Again, there were few side effects in adolescents.
A new study of adolescent migraine reported at the meeting by Dr. Winner showed that rizatriptan (Maxalt®) 5 mg was superior to placebo in achieving pain-free status at two hours, but this superiority did not reach statistical significance. Pain-free status at two hours was reported by 32 percent of the rizatriptan group versus 28 percent of the placebo-treated patients. Pain relief at two hours (defined as relief of moderate to severe pain to mild or no pain) was reported by 66 percent of the rizatriptan group compared to 56 percent of the placebo group. These results are similar to results of adult studies of rizatriptan 5 mg; in this study, the adolescents had a higher response to placebo than is commonly seen in adults. This resulted in a smaller difference between rizatriptan and placebo than is found in adult studies. Rizatriptan was superior to placebo in relief of nausea and in preventing disability. No disability was reported at two hours in 44 percent of the rizatriptan group compared to 36 percent of the placebo group. Interestingly, although rizatriptan was superior to placebo all during the week, the difference in favor of rizatriptan was even greater on the weekend, observed Dr. Winner. The study included 149 adolescents treated with rizatriptan and 147 adolescents treated with placebo. Patients' ages ranged from 12 to 17 years. Patients were asked to take their medication within 30 minutes of onset of a moderate-to-severe migraine attack, and they were allowed to take two additional doses of their study medication if necessary. This study is one of the first studies to be conducted in adolescents, and it shows that adolescent migraine can be safely and effectively treated with a triptan, said Dr. Winner. More studies are needed to determine the best drug and dose to use as well as the best time to initiate treatment in adolescents.