Self-Management Strategies for Treating Pediatric and Adolescent Headaches and Migraines with Over-the-Counter Molecules: Expert Opinion and Literature Review.

Introduction: Acute pain associated with headaches and migraines in children and adolescents may be managed with over-the-counter (OTC) treatments (e.g., paracetamol and ibuprofen); however, there are few studies on their safety and effectiveness in these patients. This narrative review evaluates the use of OTC treatments in children and adolescents with headaches and migraines.

Methods: A literature search of Embase, MEDLINE, ToxFile, and Derwent Drug File was performed for reviews of clinical studies and meta-analyses (January 2010-October 2023) related to the acute treatment of headaches and migraines in children (1 month-11 years) and adolescents (12-18 years) with OTC analgesics (paracetamol, ibuprofen, aspirin, and naproxen). The results of the literature search were interpreted alongside expert recommendations per real-world clinical experience.

Results: Twenty-eight articles were identified, of which half included recommendations that either paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs; typically, ibuprofen) were appropriate first-line OTC treatments for headache and/or migraine in children and adolescents. The remaining studies recommended ibuprofen and/or other NSAIDs (particularly naproxen) exclusively or preferentially over paracetamol. Four studies noted that aspirin was appropriate for adolescent patients > 16 years of age. An overall lack of clinical evidence on children and adolescents was noted, particularly regarding combinations of paracetamol and NSAIDs, and adjuvants such as caffeine.

Conclusion: Paracetamol appears to be effective for treating headaches and migraines in children and adolescents; however, evidence is inconclusive regarding the equivalence or superiority of NSAIDs for the same indication. Clinical judgment and patient or caregiver preferences should guide medication selection.