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[Prophylactic treatment of headache]
1Sección de Neurología Infantil; Hospital Universitario Virgen del Rocío, Sevilla, 41013, España. mrufo@nacom.es
Insights
Effective pediatric headache management requires personalized prophylactic treatment. Identifying triggers and considering behavioral therapies are key before initiating medication for chronic headaches in children.
Area of Science:
- Neurology
- Pediatrics
- Pain Management
Context:
- Headache is the most common neurological disorder in children.
- Prophylactic treatment studies for pediatric headaches are limited due to challenges in pain assessment.
- Individualized treatment is crucial, considering patient age, headache frequency, pain intensity, and family dynamics.
Purpose:
- To outline the principles of prophylactic headache treatment in children.
- To emphasize the importance of identifying headache triggers and underlying factors.
- To guide the selection and administration of prophylactic therapies for pediatric headaches.
Summary:
- Prophylactic treatment for chronic headaches in children necessitates identifying trigger factors and tailoring interventions. Behavioral therapies, psychological support, and relaxation techniques can reduce headache frequency and intensity.
- Medication is considered when non-pharmacological methods fail, with tricyclic antidepressants as a primary choice for tension-type headaches.
- Prophylactic migraine treatment in children typically starts with monotherapy for 3-6 months and may include beta-blockers, calcium antagonists, antidepressants, NSAIDs, and anticonvulsants.
Impact:
- Provides a framework for managing chronic headaches in pediatric populations.
- Highlights the need for a multimodal and individualized approach to treatment.
- Informs clinical practice regarding the appropriate use of behavioral interventions and pharmacotherapy.
Introduction:
Headache continues to be the commonest neurological disorder of childhood. There are few studies of prophylactic treatment for headache at this age, perhaps because of the difficulty in measuring intensity of pain and response to treatment in children. Before headache can be treated prophylactically, it is necessary to know its exact site and main trigger mechanisms. Therefore, treatment has to be adapted to the individual, bearing in mind the age of the patient, frequency of headaches, presence or absence of aura, intensity of pain and attitude of the family. Behavior therapy, psychological support and relaxation exercises may be necessary to reduce the frequency and intensity of the headache.
Development:
The first prophylactic treatment for chronic headache should be identification of any underlying trigger factor. Tension type headache may be a simple somatic reaction to stress. Prophylactic drugs should be given according to the frequency of headaches, their duration and intensity whenever drug treatment for the acute phase has not eased the pain completely. The tricyclic antidepressants are the initial drug of choice for use in tension headache. It should be remembered that in children drugs should only be used when other measures of pain control have proved useless. In general prophylactic treatment of migraine should be started as monotherapy, maintained for at least one month (approximately between 3 and 6 months) before gradually stopping the drug. The drugs usually used in children are adrenergic beta blockers, calcium antagonists, seretoninergenic antagonists, antidepressants, non steroid anti inflammatory drugs, and the anti convulsant drugs currently being developed.