Migraine headaches in the adolescent

Migraine headaches are common in adolescents. Characterized by recurring attacks of intense, pounding, and nauseating frontal or temporal head pain, migraine headaches are a significant contributor to school absences and lost productivity during the adolescent years and beyond. A systematic management program can be instituted to minimize these deleterious effects. The first step is to establish the diagnosis and reassure the patient that there is no serious underlying cause such as a brain tumor. The next step involves identification of lifestyle contributors followed by appropriate modification of sleep, activity, stress, diet, and other provocative influences, often with behavioral therapies. There is a vast, new pharmacologic armamentarium for the acute and preventative management of migraine. The choices depend on the headache burden: the individual patient's pattern, frequency, intensity, disability, and pain tolerance. This chapter reviews the phenomena of adolescent migraine with emphasis on office management.