Propranolol, valproic acid, and amitriptyline are effective prophylaxis for migraine in children, are widely available, and have a reasonable safety profile.
Migraine is the most common cause of chronic recurrent headaches in children. They can have a significant impact on education and social development because of school absences and inhibition of outside activities. In addition, parental stress and missed work in caring for children with migraines are issues. There are two main strategies for migraine treatment; aborting the acute event and preventing future attacks. Preventative treatment, or prophylaxis, is used to decrease and to minimize the frequency and the severity of migraine attacks. A 50% reduction in severity or frequency of migraines while on prophylactic medication is considered good.In the October 2003 edition of “The Journal of Family Practice,” a clinical enquiry was conducted in order to answer the question, “What medications best prevent migraine in children?” The current evidence supports the use of propranolol (a beta-blocker), valproic acid (an anti-epileptic), and amitryptiline (a tricyclic antidepressant). These medications have been shown to be effective prophylaxis for migraine in children, widely available and reasonably safe. Propranolol has the most favourable safety profile with very few side effects. The newer calcium-channel blocking agents, flunarizine and nimodipine, have the best evidence as migraine prophylactics in children. However, their availability, cost and side-effects limit their usefulness.In addition, cyproheptadine is widely used in children. The evidence, however, shows it to not be as effective as amitriptyline and propranolol. (Source: The Journal of Family Practice; Vol 52, No. 10: Pages 808-810.