Skip to main content
SpringerLink
Log in

The Use of Triptans for Pediatric Migraines

  • Review Article
  • Published:
Pediatric Drugs Aims and scope Submit manuscript

Abstract

Migraine headaches frequently occur in the pediatric population, with a prevalence of 3% in children 2–7 years of age, 4–11% in children 7–11 years of age, and 8–23% in children 11 years of age and older. Migraine without aura is more than twice as common as migraine with aura in children. Headaches are the third leading cause of emergency room referrals and rank in the top five health problems of children. The 2004 American Academy of Neurology’s treatment parameter for migraine in children and adolescents recommended that nasal sumatriptan be considered for acute treatment; however, data were lacking to make a decision regarding the available oral triptans at that time. The more recently released European guidelines discuss three different triptans for use in children but no specific triptan was recommended.

Currently, six of the seven available triptans have been studied for efficacy and safety in the pediatric population; however, only a few well controlled clinical studies have been conducted. Sumatriptan has the most available data on outcomes in general, with nasal sumatriptan showing the most positive results. Nasal sumatriptan is approved in children older than 12 years of age in Europe. Oral sumatriptan does not show any clinical benefit versus placebo in children. Rizatriptan and zolmitriptan have conflicting efficacy and safety data, with most studies favoring the use of oral rizatriptan and nasal zolmitriptan. Almotriptan is the first triptan to obtain a US FDA indication in adolescents with migraines lasting 4 or more hours. This approval was based upon two studies, one large clinical trial and one very small, open-label, pilot study. At this time, there are insufficient data to recommend naratriptan and eletriptan for first- or second-line use in pediatric patients with migraines. There are currently no efficacy data for frovatriptan in pediatric patients, which limits its use in this population. Adverse effects of triptans and pharmacokinetic data in children and adolescents are similar to those in adults.

The triptan class should be considered as an acute treatment option for children and adolescents with migraines, although their use is mostly ‘off-label’. Of the available triptans, there are more positive efficacy data for sumatriptan and zolmitriptan nasal sprays, and rizatriptan and almotriptan tablets than for the other triptans.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II

Similar content being viewed by others

References

  1. Lewis D, Ashwal S, Hershey A, et al., on behalf of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology 2004; 63: 2215–24

    Article  PubMed  CAS  Google Scholar 

  2. Fenichel GM. Headache. In: Fenichel GM. Clinical pediatric neurology. 5th ed. Philadelphia (PA): Elsevier Saunders, 2005: 77–89

    Google Scholar 

  3. Kabbouche MA, Linder SL. Acute treatment of pediatric headache in the emergency department and inpatient settings. Pediatr Ann 2005; 34: 466–71

    PubMed  Google Scholar 

  4. Hershey AD, Winner PK. Pediatric migraine: recognition and treatment. J Am Osteopath Assoc 2005; 105: 2–8S

    Google Scholar 

  5. International Headache Society. International classification of headache disorders. 2nd ed. Cephalalgia 2004; 24: S23–136

    Google Scholar 

  6. Winner P, Rothner AD, Putnam DG, et al. Demographic and migraine characteristics of adolescents with migraine: Glaxo Wellcome clinical trials’ database. Headache 2003; 43: 451–7

    Article  PubMed  CAS  Google Scholar 

  7. Lewis DW. Pediatric migraine. Neurol Clin 2009; 27: 481–501

    Article  PubMed  Google Scholar 

  8. Evers S. EFNS guideline on the drug treatment of migraine-revised report of an EFNS task force. Eur J Neurol 2009; 16: 968–81

    Article  PubMed  CAS  Google Scholar 

  9. European Medicines Agency. Assessment of the paediatric needs migraine [online]. Available from URL: http://www.emea.europa.eu/pdfs/human/paediatrics/22451506en.pdf [Accessed 2009 Nov 17]

  10. Taketomo CK, Hodding JH, Kraus DM. Pediatric dosing handbook. 14th ed. Hudson: Lexi-Comp, 2007–2008

    Google Scholar 

  11. Drugs for migraines. Treat Guidel Med Lett 2008; 6: 17–22

    Google Scholar 

  12. Winner P, Rothner AD, Saper J, et al. A randomized, double-blind, placebo-controlled study of sumatriptan nasal spray in the treatment of acute migraine in adolescents. Pediatrics 2000; 106: 989–97

    Article  PubMed  CAS  Google Scholar 

  13. Winner P, Rothner AD, Wooten JD, et al. Sumatriptan nasal spray in adolescent migraineurs: a randomized, double-blind placebo-controlled acute study. Headache 2006; 46: 212–22

    Article  PubMed  Google Scholar 

  14. Ahonen K, Hämäläinen ML, Rantala H, et al. Nasal sumatriptan is effective in treatment of migraine attacks in children: a randomized trial. Neurology 2004; 62: 883–7

    Article  PubMed  CAS  Google Scholar 

  15. Ueberall MA, Wenzel D. Intranasal sumatriptan for the acute treatment of migraine in children. Neurology 1999; 52: 1507–10

    Article  PubMed  CAS  Google Scholar 

  16. Hershey AD, Powers SW, LeCates S, et al. Effectiveness of nasal sumatriptan in 5- to 12-year-old children. Headache 2001; 41: 693–7

    Article  PubMed  CAS  Google Scholar 

  17. Pakalnis A, Kring D, Paolicchi J. Parental satisfaction with sumatriptan nasal spray in childhood migraine. J Child Neurol 2003; 18: 772–5

    Article  PubMed  Google Scholar 

  18. Natarajan S, Jabbour JT, Webster CJ, et al. Long term tolerability of sumatriptan nasal spray in adolescent patients with migraine. Headache 2004; 44: 969–77

    Article  PubMed  Google Scholar 

  19. Rothner AD, Winner P, Nett R, et al. One-year tolerability and efficacy of sumatriptan nasal spray in adolescents with migraine: results of a multicenter, open-label study. Clin Ther 2000; 22: 1533–46

    Article  PubMed  CAS  Google Scholar 

  20. Blumenthal HJ. Butterscotch masks the bitter taste of sumatriptan nasal spray [letter]. Headache 2001; 41: 210

    Article  PubMed  CAS  Google Scholar 

  21. MacDonald JT. Treatment of juvenile migraine with subcutaneous sumatriptan. Headache 1994; 34: 581–2

    Article  PubMed  CAS  Google Scholar 

  22. Linder SL. Subcutaneous sumatriptan in the clinical setting: the first 50 consecutive patients with acute migraine in a pediatric neurology office practice. Headache 1996; 36: 419–22

    Article  PubMed  CAS  Google Scholar 

  23. Imitrex (sumatriptan): product information. Research Triangle Park (NC): GlaxoSmithKline, 2007 Oct

  24. Winner P, Prensky A, Linder S, et al. Adolescent migraine: efficacy and safety of sumatriptan tablets [abstract]. J Neurol Sci 1997; 150: S172

    Article  Google Scholar 

  25. Korsgaard AG. The tolerability, safety and efficacy of oral sumatriptan 50 mg and 100mg for the acute treatment of migraine in adolescents [abstract]. Cephalalgia 1995; 15: S99

    Google Scholar 

  26. Hämäläinen ML, Hoppu K, Santavuori P. Sumatriptan for migraine attacks in children: a randomized placebo-controlled study. Do children with migraine respond to oral sumatriptan differently from adults? Neurology 1997; 48:1100–3

    Article  PubMed  Google Scholar 

  27. Rothner D, Asgharnejad M. Tolerability of sumatriptan tablets in the acute treatment of migraine in adolescent patients: a review of data from clinical trials [abstract]. Eur J Neurol 1999; 6: 106

    Google Scholar 

  28. Erbilen E, Ozhan H, Akdemir R, et al. A case of myocardial infarction with sumatriptan use. Pediatr Cardiol 2005; 26: 464–6

    Article  PubMed  CAS  Google Scholar 

  29. Hoffman RJ, Ginsburg BY, Nelson LS, et al. Acute coronary syndrome following subcutaneous sumatriptan administration in a child. Clin Toxicol 2005; 43: 634–5

    Google Scholar 

  30. Christensen ML, Mottern RK, Jabbour JT, et al. Pharmacokinetics of sumatriptan nasal spray in children. J Clin Pharmacol 2004; 44: 359–67

    Article  PubMed  CAS  Google Scholar 

  31. Christensen ML, Mottern RK, Jabbour JT, et al. Pharmacokinetics of sumatriptan nasal spray in adolescents. J Clin Pharmacol 2003; 43: 721–6

    PubMed  CAS  Google Scholar 

  32. Ahonen K, Hämäläinen ML, Eerola M, et al. A randomized trial of rizatriptan in migraine attacks in children. Neurology 2006 Aug; 67: E1135–40

    Article  Google Scholar 

  33. Winner P, Lewis D, Visser WH, et al., on behalf of the Rizatriptan Adolescent Study Group. Rizatriptan 5mg for the acute treatment of migraine in adolescents: a randomized, double-blind, placebo-controlled study. Headache 2002; 42: 49–55

    Article  PubMed  Google Scholar 

  34. Visser WH, Winner P, Strohmaier K, et al., on behalf of the Rizatriptan Protocol 059 and 061 Study Groups. Rizatriptan 5mg for the acute treatment of migraine in adolescents: results from a double-blind, single-attack study and two open-label, multiple-attack studies. Headache 2004; 44: 891–9

    Article  PubMed  Google Scholar 

  35. Smith TR. Efficacy and tolerability of the marketed doses of rizatriptan in children and adolescents: a retrospective review [abstract]. Cephalalgia 2001; 21:461–2

    Google Scholar 

  36. Winner P, Gladstein J, Hershey AD. Effectiveness and tolerability of rizatriptan in adolescents with migraine [abstract]. Neurology 2002; 58: A289–90

    Article  Google Scholar 

  37. Winner P, Sadowski C, Pate D. Pharmacokinetics of rizatriptan in adolescent migraineurs [abstract]. Headache 1998; 38: 411

    Google Scholar 

  38. Linder SL, Dowson AJ. Zolmitriptan provides effective migraine relief in adolescents. Int J Clin Pract 2000; 54: 466–9

    PubMed  CAS  Google Scholar 

  39. Rothner AD, Wasiewski W, Winner P, et al. Zolmitriptan oral tablet in migraine treatment: high placebo responses in adolescents. Headache 2006; 46: 101–9

    Article  PubMed  Google Scholar 

  40. Evers S, Rahmann A, Kraemer C, et al. Treatment of childhood migraine attacks with oral zolmitriptan and ibuprofen. Neurology 2006 Jun; 67: E497–9

    Article  Google Scholar 

  41. Wasiewski W, Winner PK. Zolmitriptan is well tolerated in adolescents [abstract]. Ann Neurol 1999; 46: 541

    Google Scholar 

  42. Dixon R, Engleman K, Kemp J, et al. A comparison of the pharmacokinetics and tolerability of the novel antimigraine compound zolmitriptan in adolescents and adults. J Child Adolesc Psychopharmacol 1999; 9: 35–42

    Article  PubMed  CAS  Google Scholar 

  43. Lewis DW, Winner P, Hershey AD, et al., on behalf of the Adolescent Migraine Steering Committee. Efficacy of zolmitriptan nasal spray in adolescent migraine. Pediatrics 2007; 120: 390–6

    Article  PubMed  Google Scholar 

  44. Rothner A. Efficacy and safety of naratriptan tablets in adolescent migraine [abstract]. J Neurol Sci 1997; 150: S106

    Article  Google Scholar 

  45. Sallucci C. Naratriptan vs. ibuprofen in acute migraine treatment in children [abstract]. Cephalalagia 2000; 20: 287

    Article  Google Scholar 

  46. Pharmacokinetics of naratriptan in adolescent subjects with a history of migraine. J Clin Pharmacol 2001; 41: 170–5

  47. Charles JA. Almotriptan in the acute treatment of migraine in patients 11–17 years old: an open-label pilot study of efficacy and safety. J Headache Pain 2006 Apr; 7: E95–7

    Article  Google Scholar 

  48. Linder SL, Mathew NT, Cady RK, et al. Efficacy and tolerability of almotriptan in adolescents: a randomized, double-blind, placebo-controlled trial. Headache 2008; 48: 1326–36

    Article  PubMed  Google Scholar 

  49. Baldwin JR, Fleishaker JC, Azie NE. A comparison of the pharmacokinetics and tolerability of the anti-migraine compound almotriptan in healthy adolescents and adults. Cephalalgia 2004; 24: 288–92

    Article  PubMed  CAS  Google Scholar 

  50. Winner P, Linder SL, Lipton RB, et al. Eletriptan for the acute treatment of migraine in adolescents: results of a double-blind, placebo-controlled trial. Headache 2007; 47: 511–8

    Article  PubMed  Google Scholar 

  51. Elkind AH, Wade A, Ishkanian G. Pharmacokinetics of frovatriptan in adolescent migraineurs. J Clin Pharmacol 2004; 44: 1158–65

    Article  PubMed  CAS  Google Scholar 

  52. Lewis DW, Winner P, Wasiewski W. The placebo responder rate in children and adolescents. Headache 2005; 45: 232–9

    Article  PubMed  Google Scholar 

  53. US Food and Drug Administration. Drugs@FDA.gov: FDA approved drug products. US FDA database [online]. Available from URL: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/ [Accessed 2009 Aug 11]

Download references

Acknowledgements

We would like to acknowledge Lindsey Lester, PharmD, for her editorial assistance with this manuscript. No sources of funding were used to prepare this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

  1. Auburn University Harrison School of Pharmacy, Huntsville, Alabama, USA

    Lea S. Eiland

  2. Department of Pharmacy, Huntsville Hospital, Huntsville, Alabama, USA

    Melissa O. Hunt

Authors
  1. Lea S. Eiland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melissa O. Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lea S. Eiland.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Eiland, L.S., Hunt, M.O. The Use of Triptans for Pediatric Migraines. Pediatr-Drugs 12, 379–389 (2010). https://doi.org/10.2165/11532860-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11532860-000000000-00000

Keywords

Search

Navigation