Adolescent Migraine: Q & A with Dr. Alex Feoktistov

With 28% of adolescents between 15-19 years suffering from migraine, it can affect participation in school, sports, work, or other important activities.1

Alex Feoktistov, MD, Ph.D., is the founder and the president of the Synergy Integrative Headache Center in Chicago, Illinois. In his Q & A interview, Dr. Feoktistov discusses adolescent migraines below.

What is adolescent migraine?

Migraine is a genetically predisposed condition that usually starts in childhood or during adolescence. Although migraine headache can begin in adulthood, migraine beginning in childhood or adolescence is the pattern we see most often.

What are the symptoms?

It usually presents as a complex of symptoms including headache, increased sensitivity to light and loud noises, nausea, and occasionally vomiting. The head pain may be located in one or both temples or spread to the entire head and affect the face (sinuses area) or even the neck. Another condition that we frequently observe in younger patients (in childhood) is abdominal migraine, when patients may frequently experience unexplained stomach aches, nausea, etc. As these patients grow older, the abdominal pain usually goes away, and more typical migraine headaches emerge.

Do those with it tend to have migraine as adults?

Unfortunately, that is the case in most patients. With that being said, we sometimes see that some patients (especially boys) “grow out of migraine” after puberty or notice a significant reduction in migraine frequency and/or severity. Although clinical improvement can occur, we still recommend being proactive and consider treatment, whether acute or prophylactic.

What nonmedicinal measures can be taken?

There are a number of non-pharmacological options to treat migraine. We recommend patients try and identify potential food triggers. That could be done by following a low tyramine diet as one example. We recommend patients not skip meals and always stay well hydrated. Regular sleep and aerobic exercises are also important. Some vitamins and supplements might be beneficial, including magnesium and vitamin B2 (riboflavin).

Neuromodulation devices

There is also a relatively novel field of non-medicinal migraine treatment - non-invasive neuromodulation. That involves stimulation of a specific nerve or nerves in an attempt to either stop an ongoing migraine or prevent one from occurring. One of these devices is a non-invasive vagus nerve stimulator - gammaCore - which was also approved for use in adolescents earlier this year. The use of this stimulation modality has been investigated and researched heavily over the past several years, and the results have been published demonstrating significant clinical benefit and excellent safety. It is a handheld device that is pretty easy to use and requires only a few minutes of stimulation.

What acute medications are usually used?

There are a number of acute medications that patients should take as needed at migraine onset. The outcome of that treatment ideally should be the achievement of complete pain relief or headache freedom. For that purpose, patients may try triptans (such as rizatriptan, zolmitriptan, etc.). If a patient is 18 years or older, they may also try a novel class of acute medications called gepants (ubrogepant/Ubrelvy or rimegepant/Nurtec ODT). There are nonsteroidal anti-inflammatory medications that might also be helpful.

What preventive medications are usually used?

There is also an extensive class of migraine prophylactic medications that should be used on a regular basis and help with an overall reduction in migraine frequency. For example, some blood pressure medications, antiseizure medications, certain antidepressants, CGRP monoclonal antibodies (a recently developed new class of medications specifically developed to treat migraine headaches). Those 18 years or older and experiencing chronic migraine (15 headache days per month or more) might benefit from Botox treatment.

When should a specialist be seen?

If a patient experiences migraine-related disability, is unable to control their migraine effectively, or is noticing an increase in migraine attack frequency, I would recommend they see a specialist. If a patient is unhappy with their current medications (which may be effective in terms of headache relief but may be producing side effects), I would strongly suggest discussing it with the specialist. In this day and age, we have a number of highly effective and safe migraine-specific medications and non-pharmacological treatment options. I firmly believe that treatment can and should be tailored to each individual patient. With the appropriate and effective treatment in place, patients should not need to compromise - they should be able to live life to its full potential.

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