A 2016 review article discussing the treatment of pediatric migraine highlights that acetaminophen and ibuprofen are the most commonly used over-the-counter options for pain relief and fever reduction in children. Both are effective and well tolerated, though ibuprofen is considered a better option for pain relief. However, the authors note that, based on their clinical experience, a combination of acetaminophen and a caffeine compound given at the onset of a migraine can provide faster and more effective relief than either agent alone. Ergot-based therapies, such as dihydroergotamine and ergotamine combined with caffeine, may also be beneficial during a migraine attack but should be used cautiously due to their vasoconstrictive effects; an angio-MRI may be considered before prescribing a caffeine-containing medication. Despite being a viable therapeutic agent, the authors emphasize that caffeine can still act as a migraine trigger, highlighting the importance of identifying and avoiding potential triggers. Of note, optimal caffeine dosing for pediatric patients was not specified in the review. [1]
Another review article discusses caffeine in headache management, highlighting its use in both adult and pediatric patients. Notably, only one study was referenced for pediatric use (see Table 1). In this study, ibuprofen-caffeine combinations were compared to ibuprofen alone in children with migraine or tension-type headache. Although limited by sample size and without statistically significant results, the combination showed faster and greater pain relief, with nearly 60% of children experiencing meaningful benefit. Overall, the authors note that caffeine is widely consumed and has important medical uses, mainly as an adjuvant in combination with analgesics for acute treatment of tension-type headache and migraine. However, further research is needed to better define its role and optimal dosing, particularly in pediatric populations. [2]