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Clinician’s Corner: Treatment of Migraine Headache In Special Populations

Treatment of migraine headache in Children

In kids the pain is most often on both sides, unlike adult migraine. Symptoms include sensitivity to light and sound, nausea, vomiting, and movement sensitivity

  • Treatment (acute): Ibuprofen (Motrin)
  • Acetaminophen (Tylenol is a 2nd
  • If not effective, try sumatriptan (Imitrex®) nasal spray
  • Children age 6 to 10 years old weighing less than 110 lbs. should begin with the smallest available dose of triptan. (Sumatriptan-25mg)
  • Treat early for maximum effectiveness.

Treatment of migraine headache in Pregnancy

Migraine treatment of choice for pregnant patient: 1000mg Acetaminophen + 10mg metoclopramide (Reglan).

Second line: May also use butalbital/APAP/caffeine (Fioricet) or Acetaminophen/codeine #3 (Tylenol #3).

REBOUND HEADACHES (MOH: Medication Overuse Headache) Key points: 

 What it looks like:

  • Headache – 15 or more days per month in a patient with a pre-existing headache disorder
  • Regular overuse for more than three months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache:

Overuse of headache medications whether prescription or OTCs for just a few months can make their headaches worse when patients take meds frequently for migraine or tension headaches.

Caution patients to avoid using these drugs most likely to cause medication overuse headache:

  • butalbital/ acetaminophen (Fioricet)
  • acetaminophen (Tylenol)
  • an opioid (Percocet or Norco) for 8 or more days/month
  • aspirin analgesics (Excedrin, Bufferin)
  • Triptans: do not use more than 10-14 days per month. That is why drugs like sumatriptan are packaged in 9 tablet boxes.
  • Motrin, Aleve for 10 or more days/month.
  • Strategy for treating medication overuse headache:
    • Stop abruptly the over-used meds like NSAIDS and triptans
    • Taper butalbital and opioids.

Treatment of withdrawal headaches:  symptoms: worsening headache, anxiety, nausea or vomiting, disturbed sleep present for several days or longer.

  • Select a drug from another class
  • Treat nausea and vomiting
  • Prednisone 100 mg/day for 5 days helps with inflammation but not pain.


  • Chart your symptoms, even those that seem unrelated to headaches.
  • Be sure to include dates, times, and weather.
  • Chart what you were doing, eating, or drinking before the headache began. Log the duration of the headache.
  • Log the medications you took to treat the headache and their efficacy

 AVOID opioids and butalbital for headache treatment!!

 USE Migraine prevention therapy… we’ll discuss next week.

Your Thompson Pharmacists wants you to feel better and get relief from your migraine headaches.  Unfortunately, some of the medications prescribed can CAUSE headache if overused.  Our pharmacist can help you with those prescription and over-the-counter meds.  Go Ahead and ASK…at Thompson Pharmacy it’s ALL for YOU!!!