Sumatriptan Nasal Spray: an effective abortive therapy in childhood migraine

A recent study has shown sumatriptan nasal spray to be an effective and well tolerated therapy in paediatric patients aged 5-12years when used as an abortive treatment for their migraine attacks.

Migraine headaches are a common occurrence in children with prevalence rates ranging from 3.2% to 10.5%. The triptans, a class of medications that act as serotonin agonists, are an effective abortive treatment in adult migraine. However, their usefulness in the paediatric population has not been clearly documented. Infact, currently no triptans are approved for use in children.At present the mainstays of abortive therapy for treating paediatric migraines have been over-the-counter analgesics such as acetominophen and ibuprofen. The problem with these medications being that they are administered orally and unfortunately paediatric migraine is often associated with nausea and vomiting, giving these medications limited utility.The clinical features of paediatric migraine vary from that of adults in that they are generally of shorter duration and often occur in association with nausea and vomiting. Hence, the rapid onset of action of nasal spray has distinct advantages in children as does the mode of delivery, given that oral absorption is impaired.In a paper published in the most recent edition of the “Journal of Child Neurology,” an Ohio study group conducted a retrospective chart review of migraine patients from their headache clinic, aged 5-12years, who were treated with a standardized dosing regimen of sumatriptan nasal spray. These patients had previously failed over-the-counter therapy with ibuprofen or acetaminophen. Parental satisfaction with sumatriptan nasal spray was assessed by patient or guardian report via a written standardized questionnaire.The study aim was to assess paediatric therapeutic response and tolerability of sumatriptan nasal spray.Of the one hundred patients that were identified and asked to fill in the questionnaire, 57 families completed it. Forty-four of the 57 families (77%) reported good to excellent headache relief of their child’s migraine attacks, with 93% of those families reporting continuing use of the sumatriptan nasal spray. Five patients discontinued the sumatriptan nasal spray owing to side effects, bad taste being the most common,and two patients discontinued the medication related to difficulty in using the spray.In this cohort of paediatric patients, sumatriptan nasal spray was an effective and well tolerated abortive therapy for acute migraine attacks. However, the retrospective nature of the study indicates the possibilty of selection bias. Hence, a larger prospective randomized trial is needed to verify the observations seen in this study. (Source: Journal of Child Neurology 2003; Vol 18: Pages 772-775)