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Merison K, Jacobs H. Diagnosis and Treatment of Childhood Migraine. Curr Treat Options Neurol. 2016;18(11):48doi: 10.1007/s11940-016-0431-4.
Merison, K., & Jacobs, H. (2016). Diagnosis and Treatment of Childhood Migraine. Current treatment options in neurology, 18(11), 48. https://doi.org/10.1007/s11940-016-0431-4
Merison, Kelsey, and Jacobs, Howard. "Diagnosis and Treatment of Childhood Migraine." Current treatment options in neurology vol. 18,11 (2016): 48. doi: https://doi.org/10.1007/s11940-016-0431-4
Merison K, Jacobs H. Diagnosis and Treatment of Childhood Migraine. Curr Treat Options Neurol. 2016 Nov;18(11):48. doi: 10.1007/s11940-016-0431-4. PMID: 27704257.
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Curr Treat Options Neurol. 2016 Nov;18(11):48. doi: 10.1007/s11940-016-0431-4.

Diagnosis and Treatment of Childhood Migraine.

Current treatment options in neurology

Kelsey Merison, Howard Jacobs

Affiliations

  1. Division of Child Neurology, Nationwide Children's Hospital, Columbus, OH, USA.
  2. Division of Child Neurology, Ohio State University, Nationwide Children's Hospital, FB, Suite 4A.4-4814, 700 Children's Drive, Columbus, OH, 43205, USA. [email protected].

PMID: 27704257 DOI: 10.1007/s11940-016-0431-4

Abstract

OPINION STATEMENT: While the diagnosis of migraine in children is generally straightforward, treatment can seem complex with a number of medication choices, many of which are used "off label." Patients with intermittent migraines can often be managed with ibuprofen or naproxen taken as needed. Unfortunately, by the time that children present to our practice, they have often tried these medications without improvement. Triptans are frequently prescribed to these patients with good success. It is important to make the patient aware of the possible associated serotonergic reactions. If the patient is having more than one headache per week or the headaches are prolonged, prophylactic treatment is indicated. In our practice, the overwhelming majority of these patients will be treated with amitriptyline or topiramate. We generally allow side effect tolerability to guide our choice of medication. Cyproheptadine is often used in younger patients as it comes in a liquid form. There is evidence supporting the use of propranolol, though the potential worsening of underlying asthma symptoms may limit its use, and sodium valproate, which must be used with caution in female patients of childbearing age due to significant teratogenicity risks. Other prophylactic treatments with less robust evidence include the antiepileptic drugs gabapentin, zonisamide, and levetiracetam; calcium channel blockers such as verapamil and amlodipine; and the angiotensin receptor blocking agent candasartin (not available in the USA). Almost all patients in our practice are advised to take magnesium supplementation. Magnesium is a supplement with relatively few adverse effects and good evidence for improvement of migraine symptoms. We evaluate lifestyle issues and comorbidities in all our patients. Ignoring these will make successful treatment near impossible. Good sleep, adequate hydration, appropriate diet, and exercise are vitally important. Finally, most of our patients benefit from a psychology evaluation with cognitive behavioral therapy. Stress management and biofeedback are tremendously helpful in improving quality of life in migraineurs.

Keywords: Abortives; Cognitive behavioral therapy; Comorbidities; Pediatric migraine; Prophylaxis

References

  1. Headache. 2010 Jun;50(6):1089-99 - PubMed
  2. Semin Pediatr Neurol. 1995 Jun;2(2):109-18 - PubMed
  3. Headache. 2006 May;46(5):766-72 - PubMed
  4. Headache. 2016 Jan;56(1):113-7 - PubMed
  5. Curr Pain Headache Rep. 2013 Jun;17(6):341 - PubMed
  6. Dev Med Child Neurol. 2010 Dec;52(12):1088-97 - PubMed
  7. Cephalalgia. 2006 Apr;26(4):361-72 - PubMed
  8. J Child Neurol. 2007 Jul;22(7):829-35 - PubMed
  9. Headache. 2014 Feb;54(2):235-45 - PubMed
  10. Curr Pain Headache Rep. 2014 Oct;18(10):454 - PubMed
  11. Pediatr Neurol. 2016 May;58:37-40 - PubMed
  12. Headache. 1993 Feb;33(2):76-81 - PubMed
  13. Int J Immunopathol Pharmacol. 2012 Oct-Dec;25(4):1083-91 - PubMed
  14. Headache. 2011 Jul-Aug;51(7):1058-77 - PubMed
  15. Neurology. 2012 Nov 20;79(21):2115-21 - PubMed
  16. Curr Treat Options Neurol. 2015 Jan;17(1):326 - PubMed
  17. Headache. 2015 Feb;55 Suppl 1:39-50 - PubMed
  18. J Headache Pain. 2010 Jun;11(3):235-40 - PubMed
  19. Ann Indian Acad Neurol. 2012 Aug;15(Suppl 1):S15-22 - PubMed
  20. Pediatrics. 2007 Aug;120(2):390-6 - PubMed
  21. Int Ophthalmol Clin. 2009 Summer;49(3):27-33 - PubMed
  22. Headache. 2016 Apr;56(4):711-6 - PubMed
  23. Neuropsychiatr Dis Treat. 2014 Mar 31;10:547-52 - PubMed
  24. Headache. 2001 Nov-Dec;41(10):981-4 - PubMed
  25. Headache. 2007 Apr;47(4):511-8 - PubMed
  26. Braz J Med Biol Res. 2014 Apr;47(4):349-54 - PubMed
  27. Headache. 2015 Nov-Dec;55(10 ):1365-70 - PubMed
  28. Headache. 2012 Nov-Dec;52(10):1456-70 - PubMed
  29. Neurology. 1997 Jan;48(1):103-7 - PubMed
  30. Headache. 2005 May;45(5):590-6 - PubMed
  31. Eur J Neurol. 2012 May;19(5):703-11 - PubMed
  32. Neurology. 2012 Nov 20;79(21):2097-103 - PubMed
  33. Headache. 2016 Jan;56(1):206-14 - PubMed
  34. Cephalalgia. 2012 Jul;32(10):750-65 - PubMed
  35. Eur J Paediatr Neurol. 2005;9(5):333-8 - PubMed
  36. Mol Genet Genomics. 2012 Dec;287(11-12):837-44 - PubMed
  37. Headache. 2006 Feb;46(2):212-22 - PubMed
  38. JAMA Pediatr. 2013 Mar 1;167(3):243-9 - PubMed
  39. J Child Neurol. 2008 Nov;23(11):1300-4 - PubMed
  40. Cephalalgia. 2013 Jul;33(9):629-808 - PubMed
  41. Headache. 2015 Nov-Dec;55(10 ):1426-9 - PubMed
  42. Cephalalgia. 2009 Jul;29(7):719-28 - PubMed
  43. Pediatr Neurol. 2012 Oct;47(4):233-41 - PubMed
  44. Headache. 2016 Apr 8;:null - PubMed
  45. Cephalalgia. 2014 Apr;34(5):365-75 - PubMed
  46. Headache. 2013 Mar;53(3):491-197 - PubMed
  47. Clin Neurol Neurosurg. 2013 Sep;115(9):1775-83 - PubMed
  48. Headache. 1977 May;17(2):61-3 - PubMed
  49. Cephalalgia. 2006 Oct;26(10 ):1214-9 - PubMed
  50. Ann Neurol. 1997 Dec;42(6):885-90 - PubMed
  51. Seizure. 2013 Dec;22(10):803-11 - PubMed
  52. Semin Ultrasound CT MR. 2014 Apr;35(2):97-117 - PubMed
  53. Headache. 2011 May;51(5):693-706 - PubMed
  54. Cephalalgia. 2012 Jul;32(9):693-9 - PubMed
  55. Indian J Pediatr. 2013 Nov;80(11):920-4 - PubMed
  56. Paediatr Drugs. 2010 Aug 1;12(4):269-75 - PubMed
  57. Ann Neurol. 1990 Aug;28(2):183-7 - PubMed
  58. World J Gastroenterol. 2014 Sep 14;20(34):11950-61 - PubMed
  59. Neurology. 2006 Aug 8;67(3):497-9 - PubMed
  60. J Neurol Neurosurg Psychiatry. 2016 Jan;87(1):37-48 - PubMed
  61. J Child Neurol. 2011 Aug;26(8):949-55 - PubMed
  62. Headache. 2003 Jun;43(6):601-10 - PubMed
  63. Pediatr Int. 2012 Jun;54(3):393-6 - PubMed
  64. Cephalalgia. 2010 Oct;30(10):1179-86 - PubMed
  65. Int J Clin Pract. 2000 Jun;54(5):281-6 - PubMed
  66. Headache. 2013 Jan;53(1):225-6 - PubMed
  67. Headache. 1994 Nov-Dec;34(10):578-80 - PubMed
  68. Ann Neurol. 1993 Jan;33(1):48-56 - PubMed
  69. Am J Emerg Med. 2012 Mar;30(3):456-63 - PubMed

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