Self-Management Strategies for Treating Pediatric and Adolescent Headaches and Migraines with Over-the-Counter Molecules: Expert Opinion and Literature Review

Acute pain associated with headaches and migraines in children and adolescents may be managed with over-the-counter (OTC) treatments (e.g., paracetamol and ibuprofen); however, there are few studies on their safety and effectiveness in these patients. This narrative review evaluates the use of OTC treatments in children and adolescents with headaches and migraines. A literature search of Embase, MEDLINE, ToxFile, and Derwent Drug File was performed for reviews of clinical studies and meta-analyses (January 2010–October 2023) related to the acute treatment of headaches and migraines in children (1 month–11 years) and adolescents (12–18 years) with OTC analgesics (paracetamol, ibuprofen, aspirin, and naproxen). The results of the literature search were interpreted alongside expert recommendations per real-world clinical experience. Twenty-eight articles were identified, of which half included recommendations that either paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs; typically, ibuprofen) were appropriate first-line OTC treatments for headache and/or migraine in children and adolescents. The remaining studies recommended ibuprofen and/or other NSAIDs (particularly naproxen) exclusively or preferentially over paracetamol. Four studies noted that aspirin was appropriate for adolescent patients > 16 years of age. An overall lack of clinical evidence on children and adolescents was noted, particularly regarding combinations of paracetamol and NSAIDs, and adjuvants such as caffeine. Paracetamol appears to be effective for treating headaches and migraines in children and adolescents; however, evidence is inconclusive regarding the equivalence or superiority of NSAIDs for the same indication. Clinical judgment and patient or caregiver preferences should guide medication selection.