Treating migraines in adolescents

Treating migraines in adolescents presents some unique challenges.  Besides difficulties, such as getting them to bed before midnight and getting them to improve their diets, we face the problem of not having any FDA-approved drugs to treat migraine attacks.  And it is not for lack of trying on the part of makers of triptans, which are drugs that work miracles for many adult headache sufferers.  The problem has been proving to the FDA that these drugs work in kids.  Because children tend to have shorter attacks, by the time we try to assess the efficacy of a particular drug two and four hours after the pill is taken, the headache is gone even if the pill was a placebo.  Many studies have shown that the triptans are safe and effective (as was observed in kids who have longer duration of attacks).   Many, but far from all headache specialists use triptans, such as Imitrex and Maxalt in adolescents.  A study just published in Headache proved that Axert, another drug in the triptan family and that was tested in 866 children, is effective in children 15 to 17 years of age.  The bottom line is that triptans can be safely used in kids who suffer from severe migraine headaches.  I am often asked by other physicians, what is the youngest age I would prescribe a triptan?  Because of a shortage of pediatric neurologists I feel compelled to see children as young as 10 and this is the youngest age at which I will prescribe triptans.