LOS ANGELES – In any given year, 6% of adolescents aged 12–19 years experience at least one migraine headache, according to the American Migraine Prevalence and Prevention Study released at the annual meeting of the American Headache Society.
Nearly a third of those teenagers have migraines so frequent and severe that they should be offered preventive therapy or at least be considered potential candidates for a prevention regimen, based on thresholds set by a consensus of headache specialists, according to Dr. Paul Winner, director of the Palm Beach Headache Center in West Palm Beach, Fla. Yet only 11% of teenage migraineurs receive such treatment.
The national prevalence study drew from results of validated questionnaires sent to 120,000 households representative of the U.S. population. Among 18,714 respondents whose descriptions of their headaches met the International Headache Society criteria for migraine, 1,178 were adolescents.
The 1-year prevalence for migraine among these respondents was 5% of males and 7.7% of females, with a female predominance that rose through early adolescence to peak in those aged 15–16 years, when 8.1% of females reported migraines.
Nearly 60% of the adolescents used over-the-counter (OTC) medications to treat their migraines, 16.5% relied on prescription medications, and 22% used a combination of OTC and prescription medications for their acute headaches.
An expert panel linked to the study determined by consensus the factors that should warrant consideration or an offer of a medication that could be taken on a regular basis to reduce the number or severity of migraines. The preventive medications noted include anticonvulsants, blood pressure medications, and antidepressants shown to reduce the frequency of migraines.
For example, the panel's consensus was that preventive therapy should be offered to any patient with six or more migraines per month, when some of those migraines involve severe impairment of activities and require bedrest.
Among the adolescents in the study, 21% met consensus threshold for an offer of preventive therapy and 10% would be considered potential candidates for such therapy, said Dr. Winner. There was no indication for preventive therapy in 69%.
Some adolescents who were candidates for preventive therapy had used it in the past or were using such a medication for another indication. But one in four candidates for a preventive medication had never used one.
Dr. Winner noted that up to 40% of adolescents “cycle in and out of migraines,” with gaps in time when they suffer no such headaches. Another 30% suffer one migraine and never develop another.
However, within the remaining population with migraines, there is a vulnerable group of adolescents who risk progression to transformed migraine, sometimes within just 2 years.
Future research is underway to determine whether adolescent patients who appropriately receive preventive medications for frequent and severe migraines will be less likely than others to develop transformed migraines, Dr. Winner said.
The study was sponsored by an unrestricted grant from Ortho-McNeil Inc.