Pediatric migraine: recognition and treatment.

Area of Science:

• Neurology
• Pediatrics
• Headache Medicine

Background:

• Migraine diagnosis in children often mirrors adult criteria.
• Key differences exist, including shorter attack duration and potential bilateral pain in pediatric migraineurs.
• Understanding these distinctions is crucial for accurate diagnosis and effective management.

Purpose of the Study:

• To outline diagnostic considerations for childhood migraine.
• To review current treatment modalities for acute and preventive care.
• To highlight the importance of biobehavioral therapies in long-term pediatric migraine management.

Main Methods:

• Review of diagnostic criteria for pediatric migraine.
• Analysis of treatment strategies including acute medications, preventive pharmacotherapy, and biobehavioral interventions.
• Discussion of challenges in clinical trials, such as high placebo response rates.

Main Results:

• Pediatric migraine attacks are often shorter and can be bilateral, unlike in adults.
• Acute treatments include NSAIDs, oral and nasal triptans, with limited use of subcutaneous sumatriptan and parenteral dihydroergotamine.
• Preventive options encompass antidepressants, anticonvulsants, and antihistamines, alongside essential biobehavioral therapies.

Conclusions:

• Childhood migraine requires tailored management considering its unique characteristics.
• A multimodal approach combining pharmacologic and non-pharmacologic strategies ensures optimal long-term outcomes.
• Medications used in pediatric migraine have demonstrated safety, despite challenges in controlled trial efficacy due to placebo effects.