Pediatric migraine affects 10-15% of school-aged children, contributing significantly to disability and academic impairment.1 Traditional preventive therapies, including topiramate, propranolol, amitriptyline, sometimes combined with cognitive behavioral therapy, have provided important treatment options. However, variable pediatric efficacy with frequent tolerability limitations may influence long-term adherence.2
The identification of calcitonin gene-related peptide (CGRP) as a central migraine mediator has revolutionized therapeutics. CGRP, a 37-amino acid neuropeptide, orchestrates trigeminovascular activation, neurogenic inflammation, and pain signaling within migraine pathophysiology.3
The first anti-CGRP monoclonal antibody recently received FDA approval for preventive treatment in pediatric patients 6 years and older.4 This milestone distinguishes CGRP inhibition as the first biologic strategy purpose-built for migraine prevention in adolescents.
Preventive strategies for pediatric migraine now span a diverse range of options, from traditional daily oral agents with broad neurological and vascular effects to newer biologic therapies that target migraine-specific pathways.2 Oral preventives remain valuable choices for many patients, particularly when comorbid conditions align with their mechanisms of action. More recently, monoclonal antibodies directed against CGRP provide a sustained, pathway-specific intervention with monthly dosing, which may support adherence in adolescents. This expanding therapeutic landscape allows clinicians to individualize care, selecting the right approach based on patient characteristics, preferences, and clinical goals.5,6
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