The findings suggest to Dr. Hershey, “It’s not so much what we do but how we do it. We offer options: ‘Do headaches bother you enough to take a preventive medication every day?’ We give patients the choice, and the expectation of a response drives a clinically positive result.

“We can use that expectation clinically, telling patients they don’t have to be on medication very long. When the frequency of headaches declines to two or three times a month and the headaches go away in an hour, they can stop preventive medication and use an acute therapy to treat the headache when it occurs.”

Based on the results of the CHAMP trial, Dr. Christina L. Szperka, pediatric neurologist and director of the pediatric headache program at Children’s Hospital of Philadelphia, suggests that clinicians first try a nutraceutical like magnesium or riboflavin (vitamin B2) to reduce headache frequency, along with lifestyle measures like staying well hydrated, eating regular meals, not skipping breakfast, getting enough sleep and getting some exercise.

She told NeurologyLive: “If the act of taking something like a pill every day and believing it is likely to help you and is part of what triggers the body’s response to heal itself, then we feel like it makes sense to think about using something that’s pretty harmless to start the process. If they don’t respond to those nutraceuticals, then that’s when we bring in the other prescription medications.”

Dr. Amy Gelfand, director of the child and adolescent headache program at the University of California, San Francisco, has found that taking melatonin along with riboflavin can also help to reduce the frequency of migraine attacks. Melatonin is the body’s natural sleep-inducing hormone and is available in pharmacies without a prescription.

“Too often kids and families are told nothing can be done about migraine,” Dr. Gelfand said. “That’s the wrong message. The kids who are being treated are doing really well.”

One often overlooked contributor to attacks of migraine is stress. Dr. Szperka told me, “Stress is a huge factor in migraine. Kids have told us, ‘If I’m worried about something, that’s when I have my headache.’ Kids today are under so much pressure to do well in school and in sports if they want to get into a good college. They push themselves and suffer. Sometimes the best suggestion to them is to ease up academically.”