Advances in Pediatric Migraine Pharmacology: Compound Sumatriptan an Effective Treatment
For parents, the only thing worse than dealing with a lot of pain is watching their children suffer through pain. Parents who are familiar with the singular pain of migraine headaches would give almost anything for their children to not experience them. Adolescent and pediatric headaches may strike up to 82 percent of adolescents and children before the age of 15, with an additional 5 percent of children and teenagers in the US experiencing at least one migraine annually. Traditionally, advances in medication for pediatric and adolescent migraine therapy have been very slow in coming, but with the approval of the highly effective compound sumatriptan and naproxen sodium, pharmacists will have more weapons in the fight to help our kids with excruciating migraine pain.
Up until 2015, the U.S. Food and Drug Administration had only approved two medications for pediatric patients, almotriptan and rizatriptan, both of which began as medications for adult migraine patients and were expanded to children and adolescents later on. The wide range of pharmacology options available for pharmacists and doctors for their adult patients simply have not been there for pediatric and adolescent migraine patients, even though migraines may arguably disrupt more life activities for children and teens, and occur more often than in the adult population.1
Sumatriptan and Naproxen Sodium for Pediatric and Adolescent Migraine Treatment
Both sumatriptan and naproxen sodium are used as migraine treatments for adults, but the breakthrough combination of the two treatments and the compound medication’s effectiveness in children and adolescents significantly contributes to relief of migraines. The medication goes beyond merely managing migraine symptoms and pain relief to actually treat some of the sources of migraine genesis.
Pharmacists are not exactly sure how sumatriptan works to prevent migraines and abort acute migraine episodes, but it is likely related to the effects of serotonin receptor stimulation. The sumatriptan stimulates the 5-HT1B receptor, resulting in vasoconstriction. At the same time, the activation of the 5-HT1D receptor inhibits neurogenic inflammation, while brainstem receptor stimulation prevents neural sensitivity—all resulting in generally analgesic effects with regard to oncoming and occurring migraines. Sumatriptan can be compounded as a nasal spray to prevent with potential gastrointestinal complications.
Naproxen sodium is a non-steroidal anti-inflammatory drug (NSAID) for treating migraines with or without aura, and the combination of the NSAID with the triptan produces generally more effective analgesic and anti-inflammatory effects. The combination drug is considered “grade A methodology” for migraine treatment. The development arose from experimentation with triptans and NSAIDs as first- and second-line treatments (and vice versa) and can even be effective for patients who previously did not respond to triptans as treatment.2
The FDA approved combined sumatriptan and naproxen sodium in spring 2015 following a phase 3 safety trial and a review of long-term safety data. Clinical trials demonstrated that the combination medication shows significantly more effective rates of treatment over a placebo, and a safety profile similar to when adults are treated with the same medication.3
As with any pharmacological treatment for children and adolescents, a pharmacist should be aware of all the factors in the child’s environment and the degree to which the migraine episodes are disrupting the patient’s life. Not all migraines in children or teenagers requires drug therapy, of course, but for the instances where a pharmacological response is clearly necessary and an effective course has yet to be found, the combination of sumatriptan and naproxen sodium may be a breakthrough.
Why Pharmacists Should Be Active Participants in Migraine Pharmacology
Migraines occur in different children for different reasons, and children often have a difficult time articulating symptoms and grading pain, which can make treatment an exercise in patience. Pharmacists are in a position to be proactive in migraine treatment because pharmacology is often vital to mitigating and managing the ways in which migraines may affect children and teens.
For adolescents and children especially, pharmacists should not be afraid to be their patients’ advocates in terms of new advances in medication and working to find a therapy that works, especially because pediatricians may be less up-to-date on pharmacological advances. The best team for a child with migraines is a proactive parent, a proactive pharmacist, and a proactive primary care pediatrician working together to find a care regimen that reduces episodes and manages pain when episodes do occur.
The best migraine treatments are multi-dimensional, including pharmacological therapy to abort acute episodes and manage pain, along with encouraging adoption of better physical habits like good sleep, balanced diet, and establishing and avoiding known individual migraine triggers. Pharmacists can formulate drug responses by taking into account all the pharmacokinetic and pharmacodynamic characteristics of each child.4
The approval of combination sumatriptan and naproxen sodium for child and adolescent dosage may also alleviate some challenges for pharmacists weighing safety profiles versus the benefits of single or multi-drug therapies. The combined drug is certainly a treatment that pharmacists with adolescent or pediatric migraine patients should be discussing and exploring with guardians and primary care physicians.
Pharmacists, in general, have a crucial and unique role to play in treating recurrent and complex ailments like pediatric and adolescent migraines. New medications give pharmacists new tools and it’s on all of us in the pharmaceutical realm to make sure we’re doing everything we can to give our youngest patients the best possible quality of life.
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- “Pediatric and Adolescent Migraine,” Dec. 6, 2015, http://www.americanheadachesociety.org/assets/1/7/Paul_Winner_-_pediatric_and_Adolescent_Migraine.pdf; “Sumatriptan and Naproxen for Treatment of Migraine in Adolescents,” June 2015, http://www.medscape.com/viewarticle/850389 ↩
- “Revised French guidelines for the diagnosis and management of migraine in adults and children,” February 2014, http://www.thejournalofheadacheandpain.com/content/15/1/2; “Intranasal sumatriptan for migraine in children,” May 2015, http://www.cfp.ca/content/61/5/435.full ↩
- “FDA Okays Sumatriptan/Naproxen (Treximet) for Migraine in Teens,” May 15, 2015, http://www.medscape.com/viewarticle/844752 ↩
- “Practice Parameter: Pharmacological treatment of migraine headaches in children and adolescents,” Dec. 28, 2004, http://www.neurology.org/content/63/12/2215.full ↩