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Pediatric migraine
1Pediatric Emergency Services, Harlem Hospital Center, New York, New York, USA.
Insights
Pediatric migraine management focuses on trigger avoidance, rest, and analgesics. Behavior therapy aids symptom control, while medication use is reserved for severe cases, pending further research into migraine causes.
Area of Science:
- Pediatric Neurology
- Headache Medicine
Background:
- Migraine headaches affect about 5% of children.
- Diagnosis is typically clinical, avoiding extensive testing.
- Complicated migraines may require neuroradiology.
Purpose of the Study:
- To outline diagnostic and management strategies for pediatric migraines.
- To review current treatment options and their efficacy.
- To highlight areas for future research in migraine pathogenesis.
Main Methods:
- Review of clinical presentation and diagnostic approaches.
- Evaluation of non-pharmacological and pharmacological treatments.
- Discussion of evidence supporting current therapies.
Main Results:
- Most pediatric migraines are diagnosed via history and physical exam.
- Behavioral therapies are effective adjuncts for frequency and intensity.
- Pharmacological treatments lack extensive research support and are for severe cases.
Conclusions:
- Pediatric migraine diagnosis relies heavily on clinical assessment.
- Non-pharmacological interventions are key components of management.
- Further research is needed to understand migraine causes and improve treatments.
Abstract:
Migraine headaches are relatively common, affecting approximately 5% of all children. Although the differential diagnosis is extensive, a complete history and physical will usually lead to the correct diagnosis without laboratory or radiologic studies for most children. In cases of migraine complicated by neurologic problems, such as hemiplegia or ophthalmoplegia, neuroradiologic studies may be helpful to establish the diagnosis of complicated migraine. Treatment of migraine in children consists primarily of avoidance of triggers, rest, and simple analgesics. Behavior therapy, including relaxation-response training, has been shown to be an effective adjunct in managing both the frequency and intensity of the migraine attack. Use of pharmacologic agents for abortive and prophylactic therapy has not been extensively supported by well-designed, well-controlled research. In general, use of these agents should be restricted to the small group of children with frequent, severe attacks. Sumatriptan, a 5-HT1 receptor agonist, has shown promise in adult patients but future gains in treatment will be achieved only after a better understanding of the cause and pathogenesis of migraine.