Expanding the Future of Pediatric Migraine Care With Novel Pathways: Patricia Pozo-Rosich, MD, PhD

WATCH TIME: 3 minutes

"The migraine field is unique in that even without a clear biomarker, we’ve managed to build a growing therapeutic arsenal. With CGRP therapies as a foundation, newer approaches—such as PACAP antagonists or long-acting toxins—are now adding hope for a broader range of options that can change care in the near future."

The care for pediatric migraine has changed significantly since the International Headache Society’s first International Classification of Headache Disorders (ICHD) was published in 1988. At the time, the recognition grew that children often presented differently than adults, with preventive approaches, such as beta-blockers and tricyclic antidepressants that were beginning to be introduced.

In the early 2000s, updated revisions to the ICHD codes were made, incorporating a more refined pediatric-specific criteria. Notably, lifestyle modification–including hydration, sleep hygiene, and regular meals–became central to first-line management. As the understanding of migraine grew, so did the therapeutics, which led to calcitonin gene-related peptide (CGRP)-targeting treatments, which came into the fold in the mid-2010s. Among them was fremanezumab (Ajovy; Teva), the second CGRP medication of its class behind erenumab (Aimovig; Amgen).

In late July, years later after fremanezumab’s original approval, the FDA approved an expanded indication for the preventive treatment into pediatrics, treating patients aged 6 to 17 years with migraine. It was a notable decision, as the medication became the first CGRP-targeting treatment for both pediatric and adult migraine prevention. Patricia Pozo-Rosich, MD, PhD, a study author of SPACE, the phase 3 trial (NCT03539393) that led to fremanezumab’s expanded indication, recently sat down with NeurologyLive®.

In the discussion, Pozo-Rosich, head of the neurology department at Vall d’Hebron University Hospital, discussed the evolving treatment landscape for both pediatric and adult migraine following this decision. Throughout the discussion, she discussed how although a definitive biomarker for migraine is still lacking, insights from preclinical and clinical research are helping to identify novel pathways—such as PACAP antagonists, inflammatory mediators, and next-generation long-acting toxins—that could soon complement existing options.

REFERENCE
1. FDA Approves Expanded Indication for AJOVY® (fremanezumab-vfrm), The First Anti-CGRP Preventive Treatment for Pediatric Episodic Migraine. News release. Teva Pharmaceuticals. August 6, 2025. Accessed September 2, 2025. https://www.tevapharm.com/news-and-media/latest-news/fda-approves-expanded-indication-for-ajovy-fremanezumab-vfrm-the-first-anti-cgrp-preventive-treatment/