I did find somewhere else that a "rare" side effect of Depakote is bad headaches. You previously said he had been on them before & no headaches. Drugs can effect you different once out & back in the system. Don't ask me why. So I guess migraines w/ boys are not that uncommon.


Advances in the treatment of migraine in kids - Brief Article
Pediatrics for Parents, Sept, 2001 by Paul Winner
Over the last decade, adults with migraine have benefited greatly from the development of new migraine medications, such as the triptans. But what about kids?

Migraine is a common cause of headache among children and adolescents. Migraine often results in school absences as well as restricting sports and recreational and family activities. Kids need rapid and effective relief without unpleasant side effects.

The FDA has approved the use of ibuprofen and naproxen in children over age 2, but children and adolescents who do not get adequate pain relief with these medications need other options. To date, none of the migraine medications widely used by adults have been approved by the FDA for use by children. But help is on the way. Several recent clinical trials involving adolescents with migraine have shown that a class of migraine drugs known as the triptans can help relieve their pain as well as other symptoms such as nausea and light or sound sensitivity.

How effective and safe are the triptans for use by children and teens? Unfortunately, very little scientific information is available for treating headache in younger children age 11 and under. The larger clinical trials to evaluate the effectiveness and tolerability of the triptans have been conducted in children ages 12 to 17 years.

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Studies of migraine treatment in children and adolescents are more problematic than those conducted in adults. Unlike adults with migraine, kids often have attacks of shorter duration. In some studies, the response rate to placebo at the 2-hour point was 40% to 57% -- almost as high as the response to the medication. Most likely this occurs because some of the study participants had short-lasting migraines that improved on their own within that time period. Nonetheless, these studies have shown the triptans to be safe and well-tolerated in kids over 12, making them an appropriate option to try for adolescents who do not get adequate headache relief from ibuprofen or other analgesics.

A study looking at the long-term safety and tolerability of sumatriptan (Imitrex) nasal spray involved 431 adolescents treating more than 3,000 migraine attacks. This study demonstrated a pain relief rate of 72% for the 20 mg dose. Only 15% experienced a return of the headache within 24 hours of treatment. Sumatriptan nasal spray was well tolerated. The most common side effect was taste disturbance. For all other side effects, the nasal spray group did as well as the placebo-treated group.

In another study of adolescents treating moderate to severe migraine, sumatriptan nasal spray provided pain relief within 2 hours for 66% of study participants at the 5 mg dose and 83% of study participants at the 20 mg dose.

Rizatriptan (Maxalt) 5 mg tablets have also been studied in adolescents with migraine. Two-thirds of patients report pain relief after 2 hours, which is similar to the response rate seen in adults. Statistically significant results were seen in a subset of adolescents treating a weekend migraine, with pain relief at 2 hours in 65% of the children. The rizatriptan 5 mg tablet was well tolerated with no serious side effects. Studies of sumatriptan (Imitrex) tablets in doses of 25 mg, 50 mg, and 100 mg have demonstrated similar pain relief rate in adolescents as adults at 2 hours. Zolmitriptan (Zomig) tablets have been studied at 2.5 and 5 mg dosages. Zolmitriptan has been shown to be effective and well tolerated in a small subset of adolescents.

These various studies do leave some questions unanswered. The fact that the adolescents participating in the rizatriptan study had more impressive results when treating weekend than weekday headache suggests another possibility regarding the high placebo effect seen in these studies. If the adolescents had to go to the school nurse to receive their medication on the weekdays, the resulting delay in treatment might mean that many short lasting headaches improved on their own by the 2-hour time point, regardless of the child received a triptan or a placebo. New study designs for evaluating headache relief are now being undertaken.

For children and adolescents who are not responding to acute treatment or are missing too much school due to frequent migraines, preventive therapy should be considered. Advances in this area have been slow in coming, and very few studies have been done in this age group. Recently, a small study of 31 children ages 7 to 16 years reported a favorable response with divalproex sodium (Depakote). Just over three-quarters of study participants achieved a 50% reduction in headache frequency. Further studies are needed with this and other preventive medications to help guide proper treatment strategies.

Kids with migraine are starting to get the attention and quality care they need. The outlook for meaningful, effective and safe migraine treatment for children and teens looks great!

Reprinted with permission from Headache, Spring, 2001. Published by the American Council for Headache Education (ACHE), 19 Mantua Road, Mount Royal, NJ 08061 www.achenet.org

COPYRIGHT 2001 Pediatrics for Parents, Inc.
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