Acute treatment of migraine in children
- Robert P Cruse, DO
Robert P Cruse, DO
- Assistant Professor
- University of Missouri College of Medicine
- Section Editors
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Jerry W Swanson, MD, MHPE
Jerry W Swanson, MD, MHPE
- Section Editor — Headache
- Professor of Neurology
- Mayo Clinic College of Medicine
Migraine is the most common acute and recurrent headache syndrome in children. It is characterized by periodic episodes of headache accompanied by nausea, vomiting, abdominal pain, and relief with sleep.
The management of migraine consists of general measures, abortive treatment, and preventive treatment. An individual patient may need all three approaches. Unfortunately, there is a paucity of data from controlled, randomized, and blinded trials regarding treatment of migraine in children and adolescents [1-3]. Thus, most management recommendations are based upon experience in adults.
The acute treatment of migraine in children is reviewed here. Other aspects of pediatric migraine are discussed separately. (See "Classification of migraine in children" and "Pathophysiology, clinical features, and diagnosis of migraine in children" and "Preventive treatment of migraine in children".)
APPROACH TO TREATMENT
General precepts of acute migraine treatment include the following:
●Educating the child and family about migraine headache is an important aspect of care. A headache calendar should be maintained in order to identify triggering factors, clarify features of the attacks, and to help evaluate the effectiveness of treatment . Precipitating factors (eg, stress, poor sleep habits, irregular meals, odors), if identified, should be avoided if possible. A headache diary suitable for children can be downloaded from Boston Children’s Hospital.
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- APPROACH TO TREATMENT
- Young children
- Mild to moderate attacks
- Moderate to severe attacks
- Variable attacks
- Emergency settings
- Avoidance of medication overuse headache
- PHARMACOLOGIC THERAPY
- - Oral triptans
- - Nasal sumatriptan
- - Subcutaneous sumatriptan
- - Nasal zolmitriptan
- Sumatriptan plus naproxen
- Ergotamine drugs
- - Dihydroergotamine
- Intravenous valproate
- Other analgesics
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS