Triptans for pediatric patients

Rizatriptan (Maxalt) is the only migraine drug approved by the FDA for children as young as 6. Almotriptan (Axert), another drug in the same family of triptans, is approved for children from age 12 and up. Rizatriptan also has an advantage over almotriptan in that it is available in a “melt” formulation (Maxalt MLT), which is a wafer that melts in the mouth. This is especially important for younger children who may have difficulty swallowing solid tablets, but is also useful for migraine sufferers of any age who have severe nausea that makes swallowing tablets difficult. The study that led to the FDA approval of rizatriptan included over 900 children. Obviously, it was a positive study, however, it showed what many previous studies have also shown – children respond to placebo at a much higher rate than adults. That is after two hours many children will have good relief from taking a sugar pill. This is partly due to the fact that pediatric migraines tend to be much shorter in duration, often only one or two hours. So, regardless of what a child takes, the headache will be gone in two hours. Nasal sprays work a little faster, so they may be a little more effective in children and sumatriptan nasal spray (Imirex NS) is approved for children in Europe. Nasal spray also avoids the need to swallow tablets. Another triptan in a nasal spray form is zolmitriptan (Zomig NS) and anecdotally it is more consistently effective than sumatriptan. Zolmitriptan also doesn’t have a very unpleasant taste of sumatriptan and the amount of fluid that is being sprayed into the nose is much smaller. There have been many studies of various triptans in children and they all showed that these drugs are safe in pediatric population. Cost can be an issue since branded triptans are very expensive. Fortunately, sumatriptan (Imitrex) is now available in a generic form and by the end of 2012 rizatriptan (Maxalt, Maxalt MLT) will also lose it patent protection and become available as a generic.
Despite their safety and efficacy, triptans should not be always the first choice for pediatric migraines. Some children may respond well to ibuprofen (Advil) or acetaminophen Tylenol. Younger children should be given these drugs in a liquid form for ease of swallowing and for faster onset of action. And prophylactic measures should also be never forgotten – regular meals and sleep schedule, avoidance of sugar, exercise, biofeedback, magnesium and CoQ10 supplements, and other.