Table 2.

Prophylactic Pharmacotherapy (Dosing Based on Off-Label Pediatric Experience)

Data from Li et al,2 Sunku, Li,4 Abell et al,5 Chelminsky, Chelminsky,39 Stout et al,47 Boles et al,49 Gokhale et al,56 and Clouse et al.57

Antimigraines

Amitriptyline: start at 0.5 mg/kg and advance to 1–2 mg/kg per day QHS (adults 10–100 mg QHS). Monitor electrocardiogram QTc interval prior to starting. 1st choice >5 yrs old. SE: sedation, anticholinergic. Propranolol: 0.25–1 mg/kg per day BID or TID (adults 40 mg BID). Monitor resting heart rate. SE: hypotension, bradycardia, fatigue. Cyproheptadine: 0.25–0.5 mg/kg per day BID or TID. 1st choice <5 yrs old. SE: sedation, weight gain, anticholinergic. Alternatives: nortriptyline, imipramine.

Anticonvulsants

Phenobarbital: 2 mg/kg per day QHS. SE: sedation, cognitive impairment. Valproate: 500–1,000 mg ER QHS. SE: somnolence, hepatotoxicity. Carbamazepine: 5–10 mg/kg per day BID. SE: sedation, anticholinergic. Alternatives: gabapentin, topiramate, levetiracetam, zonisamide.

Supplements

L-carnitine: 50–100 mg/kg per day BID or TID (adults 660 mg–1 g BID or TID). SE: diarrhea, fishy body odor. CoenzymeQ10: 10 mg/kg per day BID or TID.

ER=

extended release;

SE=

side effects.