Treatment of migraine in children and adolescents. The state of the art




Migraine treatment, Pediatric headache, Childhood headache, Children and adolescents


Headaches and migraine are common in the pediatric population, being one of the most frequent symptoms reported in practice. Additionally, it is a considerably disabling condition, which brings significant burden and impairs several aspects of a child or adolescent's life, such as mental and physical health, executive functioning, school performance. Children and adolescents with migraine have higher risk of psychiatric comorbidities and psychosocial adjustment difficulties, which, in turn, compromise even more patient's well-functioning.
The present article provides the clinician with a straightforward and evidence-based approach to migraine treatment in this age group.
Treatment of migraine in children and adolescents requires a systematic and thorough approach. Clinicians should keep in mind the important burden migraine brings to a child's life, thus investigate, and properly manage comorbidities presented. Patient and parents' education is a meaningful part of the treatment. Moreover, non-pharmacological treatments, such as healthy lifestyle habits, behavioral interventions may also play beneficial roles. When preventive treatment is indicated, it should be tailored considering drug's profile of effectiveness and safety, as well as patient's comorbidities. Lack of evidence in this context must not translate in lack of action by the clinician, since there may be a relevant burden associated. Therefore, reasoning for the perspicacious clinician is of fundamental importance and may influence positively the outcomes.


Download data is not yet available.


James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, . . . Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 2018;392(10159):1789-1858 Doi: 10.1016/s0140-6736(18)32279-7 DOI:

Leonardi M, Grazzi L, D’Amico D, Martelletti P, Guastafierro E, Toppo C and Raggi A. Global Burden of Headache Disorders in Children and Adolescents 2007–2017. International Journal of Environmental Research and Public Health 2020;18(1):Doi: 10.3390/ijerph18010250 DOI:

Arruda MA, Guidetti V, Galli F, Albuquerque RCAP and Bigal ME. Childhood Periodic Syndromes: A Population-Based Study. Pediatric Neurology 2010;43(6):420-424 Doi: 10.1016/j.pediatrneurol.2010.06.016 DOI:

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38(1):1-211 Doi: 10.1177/0333102417738202 DOI:

Rossi R, Versace A, Lauria B, Grasso G, Castagno E, Ricceri F, . . . Urbino AF. Headache in the pediatric emergency department: A 5-year retrospective study. Cephalalgia 2017;38(11):1765-1772 Doi: 10.1177/0333102417748907 DOI:

Patterson-Gentile C and Szperka CL. The Changing Landscape of Pediatric Migraine Therapy. JAMA Neurology 2018;75(7):Doi: 10.1001/jamaneurol.2018.0046 DOI:

Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia 1988;8 Suppl 7(1-96)

Olesen J. The International Classification of Headache Disorders, 2nd edition: application to practice. Funct Neurol 2005;20(2):61-68

Machado LR. Cefaléias na infância e adolescência. Arquivos de Neuro-Psiquiatria 2008;66(2a):291-291 Doi: 10.1590/s0004-282x2008000200039 DOI:

Abu-Arafeh I, Razak S, Sivaraman B and Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Developmental Medicine & Child Neurology 2010;52(12):1088-1097 Doi: 10.1111/j.1469-8749.2010.03793.x DOI:

Arruda MA and Bigal ME. Behavioral and emotional symptoms and primary headaches in children: A population-based study. Cephalalgia 2012;32(15):1093-1100 Doi: 10.1177/0333102412454226 DOI:

Arruda MA, Guidetti V, Galli F, Albuquerque RCAP and Bigal ME. Primary headaches in childhood – A population-based study. Cephalalgia 2010;30(9):1056-1064 Doi: 10.1177/0333102409361214 DOI:

Wöber-Bingöl Ç. Epidemiology of Migraine and Headache in Children and Adolescents. Current Pain and Headache Reports 2013;17(6):Doi: 10.1007/s11916-013-0341-z DOI:

Arruda MA, Bordini CA, Ciciarelli MC and Speciali JG. Decreasing the minimal duration of the attack to 1 hour: is this sufficient to increase the sensitivity of the ICHD-II diagnostic criteria for migraine in childhood? The Journal of Headache and Pain 2004;5(2):131-136 Doi: 10.1007/s10194-004-0081-x DOI:

Barea LM, Tannhauser M and Rotta NT. An Epidemiologic Study of Headache Among Children and Adolescents of Southern Brazil. Cephalalgia 2016;16(8):545-549 Doi: 10.1046/j.1468-2982.1996.1608545.x DOI:

Albuquerque RP, Santos AB, Tognola WA and Arruda MA. An epidemiologic study of headaches in brazilian schoolchildren with a focus on pain frequency. Arquivos de Neuro-Psiquiatria 2009;67(3b):798-803 Doi: 10.1590/s0004-282x2009000500003 DOI:

Arruda MA, Albuquerque RCAP and Bigal ME. Uncommon Headache Syndromes in the Pediatric Population. Current Pain and Headache Reports 2011;15(4):280-288 Doi: 10.1007/s11916-011-0192-4 DOI:

Arruda MA, Bonamico L, Stella C, Bordini CA and Bigal ME. Cluster headache in children and adolescents: Ten years of follow-up in three pediatric cases. Cephalalgia 2011;31(13):1409-1414 Doi: 10.1177/0333102411418015 DOI:

Wilne SH. The presenting features of brain tumours: a review of 200 cases. Archives of Disease in Childhood 2006;91(6):502-506 Doi: 10.1136/adc.2005.090266 DOI:

Burton LJ, Quinn B, Pratt-Cheney JL and Pourani M. Headache etiology in a pediatric emergency department. Pediatric Emergency Care 1997;13(1):1-4 Doi: 10.1097/00006565-199702000-00001 DOI:

Lewis DW and Qureshi F. Acute Headache in Children and Adolescents Presenting to the Emergency Department. Headache: The Journal of Head and Face Pain 2000;40(3):200-203 Doi: 10.1046/j.1526-4610.2000.00029.x DOI:

Akinci A, Güven A, Degerliyurt A, Kibar E, Mutlu M and Citirik M. The correlation between headache and refractive errors. Journal of American Association for Pediatric Ophthalmology and Strabismus 2008;12(3):290-293 Doi: 10.1016/j.jaapos.2007.11.018 DOI:

The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33(9):629-808 Doi: 10.1177/0333102413485658 DOI:

Aaseth K, Grande RB, Kværner K, Lundqvist C and Russell MB. Chronic rhinosinusitis gives a ninefold increased risk of chronic headache. The Akershus study of chronic headache. Cephalalgia 2009;30(2):152-160 Doi: 10.1111/j.1468-2982.2009.01877.x DOI:

Arita JH, Lin J, Pinho RS, Minett TSC, de Souza Vitalle MS, Fisberg M, . . . Masruha MR. Adolescents with chronic migraine commonly exhibit depressive symptoms. Acta Neurologica Belgica 2012;113(1):61-65 Doi: 10.1007/s13760-012-0135-9 DOI:

Masruha MR, Lin J, Minett TSC, Vitalle MSS, Fisberg M, Vilanova LCP and Peres MFP. Social anxiety score is high in adolescents with chronic migraine. Pediatrics International 2012;54(3):393-396 Doi: 10.1111/j.1442-200X.2011.03555.x DOI:

Paschoal JKSF, Lin J, Pinho RS, Andreoni S, Minett TSC, Vitalle MSS, . . . Masruha MR. Psychiatric symptoms may contribute to poor quality of life in adolescents with migraine. Pediatrics International 2013;55(6):741-747 Doi: 10.1111/ped.12178 DOI:

Arruda MA, Arruda R, Guidetti V and Bigal ME. Psychosocial Adjustment of Children With Migraine and Tension-Type Headache - A Nationwide Study. Headache: The Journal of Head and Face Pain 2015;55(39-50) Doi: 10.1111/head.12510 DOI:

Arruda MA, Guidetti V, Galli F, Albuquerque RCAP and Bigal ME. Frequent headaches in the preadolescent pediatric population. Neurology 2010;74(11):903-908 Doi: 10.1212/WNL.0b013e3181d561a2 DOI:

Gorodzinsky AY, Hainsworth KR and Weisman SJ. School Functioning and Chronic Pain: A Review of Methods and Measures. Journal of Pediatric Psychology 2011;36(9):991-1002 Doi: 10.1093/jpepsy/jsr038 DOI:

Arruda MA and Bigal ME. Migraine and migraine subtypes in preadolescent children: Association with school performance. Neurology 2012;79(18):1881-1888 Doi: 10.1212/WNL.0b013e318271f812 DOI:

Wöber-Bingöl Ç, Wöber C, Uluduz D, Uygunoğlu U, Aslan TS, Kernmayer M, . . . Steiner TJ. The global burden of headache in children and adolescents – developing a questionnaire and methodology for a global study. The Journal of Headache and Pain 2014;15(1):Doi: 10.1186/1129-2377-15-86 DOI:

Rocha-Filho PAS and Santos PV. Headaches, Quality of Life, and Academic Performance in Schoolchildren and Adolescents. Headache: The Journal of Head and Face Pain 2014;54(7):1194-1202 Doi: 10.1111/head.12394 DOI:

Bellini B, Arruda M, Cescut A, Saulle C, Persico A, Carotenuto M, . . . Guidetti V. Headache and comorbidity in children and adolescents. The Journal of Headache and Pain 2013;14(1):Doi: 10.1186/1129-2377-14-79 DOI:

Guidetti V, Alberton S, Galli F, Mittica P and Salvi E. Gender, migraine and affective disorders in the course of the life cycle. Functional Neurology 2009;24(29-40)

Galli F, Canzano L, Scalisi TG and Guidetti V. Psychiatric disorders and headache familial recurrence: a study on 200 children and their parents. The Journal of Headache and Pain 2009;10(3):187-197 Doi: 10.1007/s10194-009-0105-7 DOI:

Varni JW, Limbers CA and Burwinkle TM. Impaired health-related quality of life in children and adolescents with chronic conditions: a comparative analysis of 10 disease clusters and 33 disease categories/severities utilizing the PedsQL™ 4.0 Generic Core Scales. Health and Quality of Life Outcomes 2007;5(1):Doi: 10.1186/1477-7525-5-43 DOI:

Guidetti V, Galli F, Fabrizi P, Giannantoni AS, Napoli L, Bruni O and Trillo S. Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year follow-up study. Cephalalgia 1998;18(7):455-462 Doi: 10.1046/j.1468-2982.1998.1807455.x DOI:

Galli F, D'Antuono G, Tarantino S, Viviano F, Borrelli O, Chirumbolo A, . . . Guidetti V. Headache and Recurrent Abdominal Pain: A Controlled Study by the Means Of The Child Behaviour Checklist (CBCL). Cephalalgia 2016;27(3):211-219 Doi: 10.1111/j.1468-2982.2006.01271.x DOI:

Anttila P, Sourander A, Metsähonkala L, Aromaa M, Helenius H and Sillanpää M. Psychiatric Symptoms in Children With Primary Headache. Journal of the American Academy of Child & Adolescent Psychiatry 2004;43(4):412-419 Doi: 10.1097/00004583-200404000-00007 DOI:

Virtanen R, Aromaa M, Koskenvuo M, Sillanpää M, Pulkkinen L, Metsähonkala L, . . . Kaprio J. Externalizing Problem Behaviors and Headache: A Follow-up Study of Adolescent Finnish Twins. Pediatrics 2004;114(4):981-987 Doi: 10.1542/peds.2003-1103-L DOI:

Olesen J. Preface to the Second Edition. Cephalalgia 2016;24(1_suppl):9-10 Doi: 10.1111/j.1468-2982.2003.00824.x DOI:

Lateef T, He J-P, Nelson K, Calkins ME, Gur R, Gur R and Merikangas KR. Physical–Mental Comorbidity of Pediatric Migraine in the Philadelphia Neurodevelopmental Cohort. The Journal of Pediatrics 2019;205(210-217) Doi: 10.1016/j.jpeds.2018.09.033 DOI:

Goodman R. Psychometric Properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry 2001;40(11):1337-1345 Doi: 10.1097/00004583-200111000-00015 DOI:

Barkley RA. Executive functions: What they are, how they work, and why they evolved. The Guilford Press; 2012 p.

S. G and JA N. Handbook of Executive Functioning ed Editor^editor New York: NY: Springer-Verlag; 2014 p.

White LK, Moore TM, Calkins ME, Wolf DH, Satterthwaite TD, Leibenluft E, . . . Gur RE. An Evaluation of the Specificity of Executive Function Impairment in Developmental Psychopathology. Journal of the American Academy of Child & Adolescent Psychiatry 2017;56(11):975-982.e973 Doi: 10.1016/j.jaac.2017.08.016 DOI:

Shanmugan S, Wolf DH, Calkins ME, Moore TM, Ruparel K, Hopson RD, . . . Satterthwaite TD. Common and Dissociable Mechanisms of Executive System Dysfunction Across Psychiatric Disorders in Youth. American Journal of Psychiatry 2016;173(5):517-526 Doi: 10.1176/appi.ajp.2015.15060725 DOI:

Martel MM, Pan PM, Hoffmann MS, Gadelha A, do Rosário MC, Mari JJ, . . . Salum GA. A general psychopathology factor (P factor) in children: Structural model analysis and external validation through familial risk and child global executive function. Journal of Abnormal Psychology 2017;126(1):137-148 Doi: 10.1037/abn0000205 DOI:

Neumann A, Muetzel RL, Lahey BB, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Jaddoe VW, . . . Tiemeier H. White Matter Microstructure and the General Psychopathology Factor in Children. Journal of the American Academy of Child & Adolescent Psychiatry 2020;59(11):1285-1296 Doi: 10.1016/j.jaac.2019.12.006 DOI:

Cantin RH, Gnaedinger EK, Gallaway KC, Hesson-McInnis MS and Hund AM. Executive functioning predicts reading, mathematics, and theory of mind during the elementary years. Journal of Experimental Child Psychology 2016;146(66-78) Doi: 10.1016/j.jecp.2016.01.014 DOI:

Jacobson LA, Koriakin T, Lipkin P, Boada R, Frijters JC, Lovett MW, . . . Mahone EM. Executive Functions Contribute Uniquely to Reading Competence in Minority Youth. Journal of Learning Disabilities 2016;50(4):422-433 Doi: 10.1177/0022219415618501 DOI:

Oberer N, Gashaj V and Roebers CM. Executive functions, visual-motor coordination, physical fitness and academic achievement: Longitudinal relations in typically developing children. Human Movement Science 2018;58(69-79) Doi: 10.1016/j.humov.2018.01.003 DOI:

Arruda MA, Arruda R and Anunciação L. Psychometric properties and clinical utility of the executive function inventory for children and adolescents: a large multistage populational study including children with ADHD. Applied Neuropsychology: Child 2020;11(1):1-17 Doi: 10.1080/21622965.2020.1726353 DOI:

Arruda R., Anunciacao L. and Arruda M. Executive Function in Adolescents with Chronic Headache: A Population Study. Neurology 2020

Costa-Silva MA, Prado ACA, Souza LC, Gomez RS and Teixeira AL. Cognitive functioning in adolescents with migraine. Dementia & Neuropsychologia 2016;10(1):47-51 Doi: 10.1590/s1980-57642016dn10100009 DOI:

Arruda M, Speciali J, Ciciarelli M and Bordini C. Childhood Migraine: Diagnostic Problems. Cephalalgia 1995;15(16_suppl)(82-82) DOI:

Arruda MA. No Evidence of Efficacy or Evidence of No Efficacy. JAMA Pediatrics 2013;167(3):Doi: 10.1001/jamapediatrics.2013.1105 DOI:




How to Cite

Arruda R, Arruda MA. Treatment of migraine in children and adolescents. The state of the art. Headache Med [Internet]. 2023 Sep. 30 [cited 2023 Dec. 6];14(3):161-73. Available from:




Similar Articles

You may also start an advanced similarity search for this article.