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Migraine headaches in children
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Pediatric migraine management requires individualized care beyond medication. Behavioral therapies and trigger avoidance are key to reducing headache frequency and severity in children and adolescents.
Area of Science:
- Pediatric Neurology
- Headache Medicine
Background:
- Migraine headaches are prevalent in children and adolescents.
- Evolving diagnostic criteria aid in identifying pediatric migraine syndromes.
- Migraine presentations vary widely, from mild bifrontal to severe unilateral pain with neurological deficits.
Purpose of the Study:
- To outline current understanding and management strategies for pediatric migraine.
- To emphasize the importance of individualized treatment approaches.
- To highlight the role of non-pharmacological interventions.
Main Methods:
- Review of diagnostic criteria and clinical presentations of pediatric migraine.
- Discussion of therapeutic interventions, including symptomatic, behavioral, and pharmacological approaches.
- Consideration of neurodiagnostic studies for specific clinical indications.
Main Results:
- Individualized treatment plans are crucial for effective migraine management.
- Behavioral therapy (psychological support, relaxation, biofeedback) significantly reduces migraine frequency and severity.
- Symptomatic treatment with analgesics and rest is often sufficient.
- Ergotamines and parenteral dihydroergotamine (DHE) have roles in specific severe cases.
- Long-term stabilization strategies are available for childhood migraine.
Conclusions:
- Comprehensive migraine care in children integrates pharmacotherapy with behavioral interventions and trigger management.
- Neuroimaging is reserved for cases with concerning neurological signs or symptoms.
- A multi-faceted approach ensures optimal outcomes for pediatric migraine patients.
Abstract:
Migraine headaches are common in children and adolescents, and stricter diagnostic criteria have been developed. Children have a variety of migraine syndromes, ranging from frequent, mild, bifrontal headaches to severe debilitating, unilateral pain associated with persistent motor or visual deficits. Neurodiagnostic studies are indicated in those individuals who have accompanying signs or symptoms that raise concern. The treatment of migraine must be individualized and requires more than just the use of pharmacotherapy. Reassurance and the elimination of potential triggering factors are essential components of care. Symptomatic therapy with analgesics and rest often is sufficient. Behavioral therapy, consisting of psychological support, relaxation exercises, and biofeedback training, is effective in reducing the frequency and severity of migraine. Ergotamines are valuable agents for abortive treatment, but should be reserved for use in the older child. Parenteral use of DHE is an effective treatment for the rare child who has an acute severe migraine unresponsive to other therapies. A variety of agents are available for the long-term stabilization of childhood migraine.