Migraine management in adolescents: treatment requires a multimodal approach

Background: Migraine is associated with a reduced quality of life, even in young patients. Despite this, there is no convincing evidence supporting the efficacy of pharmacological treatments for children and adolescents. New anti-calcitonin gene-related peptide (CGRP) medications, life-changing for many adult patients, are not yet available for pediatric use. There is a growing hypothesis that effective management of migraine during adolescence may reduce the risk of developing chronic migraine in adulthood. Methods: Over the past two decades, increasing evidence has highlighted the benefits of non-pharmacological treatments, especially those within the “third wave” of behavioral approaches, such as mindfulness-based protocols and Acceptance and Commitment Therapy (ACT). A therapeutic strategy based solely on pharmacological treatment is likely to be ineffective. Instead, a multimodal approach that integrates various elements, such as behavioral ones, education on health habits, nutraceuticals, and medical prophylaxis when needed, is recommended. Results: Based on our findings, the use of mindfulness-based internet protocols in young migraine patients showed promising results, with a significant decrease in headache frequency both in the short term and up to one year. Conclusions: A treatment approach based solely on pharmacological therapies is likely to be ineffective in pediatric migraine. Instead, a multimodal strategy, integrating behavioral and educational components along with pharmacological support when needed, appears more effective. Such programs may help modify the disease course, enhance the efficacy of medications, and promote a broader culture of care centered on brain health.