Acute treatment of migraine in children
- Kenneth J Mack, MD, PhD
Kenneth J Mack, MD, PhD
- Professor of Neurology and Pediatrics
- Mayo Medical School
- 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 episodes of severe headache accompanied by nausea, vomiting, photophobia, phonophobia, and abdominal pain, and is relieved by sleep.
The management of migraine consists of general measures, abortive treatment, and preventive treatment. An individual patient may need all three approaches. Unfortunately, there are limited data from high quality randomized controlled trials regarding the treatment of migraine in children and adolescents [1-3]. Thus, most management recommendations are based upon experience in adults, as well as expert opinion.
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 may identify triggering factors, clarify features of the attacks, and help evaluate the effectiveness of treatment . Precipitating factors (eg, stress, poor sleep habits, irregular meals, odors, weather changes, specific foods, menstrual cycles), 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
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS