Treatment of migraine headache in children and adolescents

Author: Carrie Morantz, Brian Torrey
Date: March 1, 2005

The American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society have released a report on treatment of migraine headache in children and adolescents. "Practice Parameter: Pharmacological Treatment of Migraine Headache in Children and Adolescents" appears in the December 2004 issue of Neurology and is available online at http://www.aan.com/professionals/practice/guideline/index.cfm#Child. The guideline has been endorsed by the American Academy of Pediatrics and the American Headache Society.

Migraine headaches are common in children and occur with increasing frequency through adolescence. An estimated 8 to 23 percent of children aged 11 to 15 years experience migraine headaches. The evaluation of a child with recurrent headaches begins with a thorough medical and family history followed by a complete physical examination with measurement of vital signs, particularly blood pressure, and complete neurologic examination including examination of the optic fundi.

Diagnosis of primary headache disorders in children rests principally on clinical criteria as set forth by the International Headache Society (IHS). In 2004, the IHS published a modified International Classification of Headache Disorders (ICHD) for primary and secondary headache disorders (see accompanying box).

Ibuprofen is effective and acetaminophen is probably effective for treating migraine headaches in children and adolescents. Among adolescents, sumatriptan nasal spray is a safe and effective method for migraine treatment. However, none of the oral triptans (rizatriptan, zolmitriptan) were found to be effective in treating migraine in children and adolescents.

According to the guideline, there is insufficient evidence to make recommendations concerning use of preventive agents such as cyproheptadine, amitriptyline, divalproex sodium, topiramate, or levetiracetam. The guideline panel found conflicting outcomes regarding the use of propranalol or trazodone for prevention of migraine, and made no recommendations for its use.

2004 International Headache Society Classification of Headache Disorders: Criteria for Pediatric Migraine Without Aura

A. Five or more attacks fulfilling features B through D

B. Headache attack lasting 1 to 72 hours

C. Headache has at least two of the following four features:

1. Either bilateral or unilateral (frontal/temporal) location

2. Pulsating quality

3. Moderate to severe intensity

4. Aggravated by routine physical exercise

D. At least 1 of the following accompanies headache:

1. Nausea and/or vomiting

2. Photophobia and phonophobia (may be inferred from their behavior)

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