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Jump to Key Points For children hospitalized with migraine, gabapentin use wasn’t associated with less pain or fewer readmissions than with no gabapentin use, an observational study showed.
“We should be cautious about assuming gabapentin is effective for pediatric migraine simply because it is commonly used,” said Maheshwor Kafle, MD, pediatric hospitalist at Phoenix Children’s Hospital in Phoenix. “Clinicians should prioritize therapies with stronger supporting evidence while also considering each patient’s individual clinical circumstances.”
Gabapentin, an anticonvulsant with neuromodulatory properties, is commonly used off-label to manage migraine. In a single-center cohort of children admitted with a primary diagnosis of migraine, 1 in 7 got the drug during their stay, as Kafle and colleagues reported at the Pediatric Hospital Medicine (PHM) 2026 conference in Kansas City, Missouri.
The evidence base for pediatric use is slim, they said, citing one study in which 7 of 12 pediatric migraineurs reported improvements in headache frequency and severity with gabapentin prophylaxis.
- Pediatric migraine admissions: gabapentin use not associated w/ lower pain scores.
- Mean pain change similar: 1.94 vs 2.14/10; P = .76.
- Gabapentin recipients had longer LOS: 3.2 vs 2.6 days; P < .001.
- Readmissions higher with gabapentin: 45% vs 34%; all time windows.
- Retrospective single-center data; confounding by severity/treatment resistance likely.
“However, robust randomized pediatric trials have not taken place to confirm those findings, and subsequent pediatric migraine reviews have continued to note the limited evidence base,” Kafle said.
In his group’s study, children prescribed gabapentin during their hospitalization had a mean change in pain scores similar to that in those who didn’t get the neuromodulator (1.94 vs 2.14 on a 10-point visual analog scale; P = .76).
Patients receiving gabapentin actually stayed in the hospital longer (median, 3.2 vs 2.6 days; P < .001) and were more likely to be readmitted (45% vs 34%; P = .00034) than those not receiving the drug.
Readmission rates were consistently higher among gabapentin recipients than among nonrecipients across all measured intervals:
- 7-day (4.5% vs 3.2%)
- Days 8-30 (7.6% vs 7.0%)
- Beyond 30 days (33.0% vs 23.8%)
The study involved a total of 2029 admissions with a primary diagnosis of migraine from 2019 through 2024 at Phoenix Children’s Hospital, a quaternary care pediatric hospital. The proportion prescribed gabapentin during their stay remained stable over time from 12.2% in 2019 to 13.4% in 2024, for a total of 291 recipients and 1738 nonrecipients.
Kafle cautioned about the potential for confounding in the retrospective study.
“We adjusted for measurable differences between the groups, but retrospective data cannot capture every factor that influences prescribing decisions,” he said. “For example, treatment resistance, headache duration before admission, prior medication failures, psychosocial factors, and clinical judgment may not be completely captured in the medical record.”
Treating physicians might have chosen gabapentin for patients with more severe illness or treatment resistance, Kafle added.
Thus, no causal conclusions could be drawn from the results, such as that gabapentin was responsible for the longer hospitalizations or higher readmission rates, he said.
The researchers called for multicenter research to move pediatric migraine treatment forward. “Ultimately, the goal is to move from observational associations toward comparative effectiveness research and, if feasible, a prospective randomized trial,” Kafle said.
The study was also limited in its ability to distinguish gabapentin prescribed for migraine from that prescribed for another indication and by the lack of data on migraine severity and duration, previous preventive and acute medication failures, concurrent medications, and the timing of gabapentin initiation.
With the limitations, the findings don’t rule out gabapentin use, particularly for patients with refractory or atypical headaches, said co-author Jean Bernard Salloum, a fourth-year medical student at Midwestern University in Glendale, Arizona.
“Our current findings are really a starting point,” he said. “They raise questions about current prescribing patterns and highlight the need for stronger evidence to guide treatment of pediatric migraine in the hospital setting.”
The authors disclosed no relevant financial conflicts of interest or relationships with industry to disclose. This study received no external funding.
Crystal Phend is an award-winning medical journalist with decades of experience reporting on clinical research and healthcare developments across specialties. When not walking the halls at a medical conference, she can be found at a keyboard in upstate New York.
