Patient information from BMJ

Migraine in children: medicines to prevent attacks

Last published:Feb 28, 2022

If you're the parent of a child or teenager who gets migraines, you know how upsetting these headaches can be. If your child gets migraines frequently, you might want to consider medicines to prevent them.

You can use our information to talk to your doctor and decide which treatments are right for your child. There are also treatments that can help your child with their symptoms during a migraine attack, whether their attacks are frequent or not. To learn more, see our leaflet Migraine in children.

Why might my child need medicines to prevent migraines?

Not everyone who gets frequent migraines needs treatment to prevent them. Sometimes people can reduce the number of migraines they get by avoiding things that bring on their attacks.

Common migraine 'triggers' include stress and certain foods, such as cheese, chocolate, and citrus fruits. 

You or your child can keep a diary to write down what your child does and eats each day, and when they get migraines. This might help you work out whether certain foods, certain activities, or stress trigger a migraine for your child.

However, your doctor might recommend medicines to prevent migraines if:

• your child gets lots of bad migraines

• your child's migraines stop them doing things: for example, they might be missing school or not have enough time for their hobbies or friends

• avoiding triggers hasn't helped enough.

What medicines are used to prevent migraines in children?

There are several medicines used to prevent migraines. Unfortunately, there isn't much research looking at how well they work for children. As a result, doctors are cautious about using these medicines in young people. They are usually prescribed by a specialist.

There are three main medicines used to prevent migraines in children. If these don't help, doctors sometimes prescribe other medicines, but this isn't common.

• Propranolol is a type of medicine called a beta-blocker. It is mainly used for heart problems, but it is also sometimes used for children and adults who get frequent migraines.

• Pizotifen is a drug often used for preventing migraines in adults.

• Topiramate is a type of drug called an anticonvulsant. It is mainly used for preventing seizures but it is also sometimes used to prevent migraines.

All of these treatments can cause side effects. For example, some children have difficulty sleeping when taking propranolol. It can also cause breathing problems in some people, and it is not recommended for children with asthma.

People taking pizotifen sometimes put on weight and feel drowsy, dizzy, or sick.

Topiramate can cause stomach pain, loss of appetite, problems sleeping, and mood changes, among other side effects.

Your doctor should discuss the possible side effects of these medicines with you before prescribing them to your child. If you have any questions or concerns about your child's treatment, be sure to talk to your doctor.

If these medicines aren't suitable for your child, or if they don't work well enough, there are other drugs that are sometimes used. But if your child needs any of these options your doctor will want to monitor them regularly for side effects.

Your doctor should discuss these treatments with you carefully before you decide what's best for your child.

How long will my child take the medicine?

Your child will take their medicine every day, but only for as long as they need it. Their doctor will regularly review their treatment, and have them stop taking their medicine for a while to see if their migraines return.

Children often stop getting migraines as they get older, or stop getting them as frequently.