Prophylactic treatments for primary headaches: migraine with or without aura, episodic tension-type headache, chronic migraine, chronic tension-type headache
| Regular prophylactic treatments | ||||
| 1. Topiramate (antiepileptic) | ||||
| 2–18 years | Oral | 0.5 mg/kg slowly up to 10 mg/kg/day, max 10 mg/kg/day, max 200 mg/day | Tabs: 25, 50, 100, 200 mg Sprinkle caps: 15, 25, 50 mg | Weight loss, paraesthesia, fatigue, drowsiness, impaired memory. There is a smaller risk of teratogenicity than with sodium valproate. |
| 2. Propranolol (β-blocker) | ||||
| 2–4 years | Oral | 200–500 µg/kg twice daily, max 4 mg/kg/day | Tabs: 10, 40, 80, 160 mg Oral solution: 5, 10, 50 mg/5 mL | Avoid abrupt withdrawal Avoid in asthma Sleep problems |
| 5–8 years | 10 mg twice daily, increasing to 30 mg twice daily | |||
| 8–12 years | 20 mg twice daily, increasing to 40 mg twice daily | |||
| 12–18 years | 30 mg twice daily, increasing to 60 mg twice daily | |||
| 3. Gabapentin (antiepileptic) | ||||
| 2–12 years | Oral | 10–20 mg/kg three times a day | Caps: 100, 300, 400 mg Tabs: 600, 800 mg | Avoid sudden withdrawal |
| 12–18 years | 300 mg three times a day, then up to max 1.2 g three times a day | |||
| 4. Sodium valproate (antiepileptic) | ||||
| 1–18 years | Oral | 10 slowly up to 40 mg/kg/day, max 1.5 g twice daily | Tabs: 100, 200, 500 mg Oral solution: 200 mg/5 mL | Weight gain, tremor. Avoid in young females of 12 years and more because of teratogenicity, intellectual disability after fetal valproate exposure and irregular periods. |
| 5. Flunarizine (calcium channel blocker, in the UK only on a named-patient basis)5 17 18 | ||||
| 5–9 years (20–40 kg) | Oral | 0.1–0.3 mg/kg/day, 2.5–5 mg once daily, max 10 mg once daily | Tabs: 5, 10 mg | Give as evening dose Sedation, weight gain, tremor, irregular periods |
| 10–18 years (>40 kg) | 10 mg once daily max 20 mg | |||
| 6. Amitriptyline (tricyclic antidepressant) | ||||
| 6–11 years | Oral | 10–20 mg at night | Coated tabs: 10, 25, 50 mg Oral solution: 25 mg/5 mL | Dry mouth, sedation, blurred vision, constipation Beware risk of cardiovascular fatality in overdose |
| 12–18 years | 25–50 mg at night | |||
| 7. Riboflavin (vitamin B2) | ||||
| 1–18 years | Oral | 50–100 mg once daily-twice daily, max 400 mg/day | Tabs: 10, 50, 100 mg | Bright yellow urine |
| 8. Pizotifen (serotonin 5-HT2 antagonist) | ||||
| 5–11 years | Oral | 500 µg increasing to 1 mg at night, max 1.5 mg/day | Tabs: 500 µg, 1.5 mg Elixir: 250 µg/5 mL | Drowsiness, increased appetite, weight gain, nausea, dizziness, anxiety, aggression |
| 12–18 years | 1.5 mg increasing to 3 mg at night, max 4.5 mg/day | |||
Some of the drugs/doses below are outwith the marketing authorisation. Always check usual reference sources/guidelines when using unfamiliar medicines.11
5-HT, 5-hydroxytryptamine; max, maximum; caps, capsules; tabs, tablets.