Migraine Headache in Childhood

Excerpt

Migraine and headache disorders are among the leading causes of disability and morbidity worldwide. Migraine is the most frequent primary headache disorder in children and adolescents. About 1 in 10 children experience recurrent headaches due to migraine, which can significantly impair school performance and quality of life.

Up to 18% of patients in the pediatric emergency room are found to be migraine-related. However, migraine in children differs from that in adults because it is often associated with other symptoms, not only headache. Migraine in children also manifests conditions like cyclic vomiting and abdominal migraine, wherein children are usually considered to have gastrointestinal tract disorder.

The diagnosis of migraine in children and adolescents remains a clinical diagnosis. The clinician must obtain a detailed and comprehensive headache history that focuses on the location, quality, severity, and duration of the pain. Nonetheless, complicated migraine is often associated with focal neurological symptoms such as ataxia, hemiparesis, or altered level of consciousness that concerns the examining clinician. Some episodic syndromes may show ambiguity, such as migraine triggered by trauma.

Acute treatment recommendations for children include using over-the-counter analgesics and triptan medications approved by the US Food and Drug Administration. Preventive treatment strategies involve lifestyle modifications, behavioral approaches, and consideration of preventive medications with the lowest side effect profiles. There are evidence-based recommendations for the acute symptomatic treatment of migraine in children, which support the efficacy of using ibuprofen, acetaminophen, and triptans. However, no acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia. Recommendations focus on the significance of early treatment, selecting the most suitable route of administration in relation to the characteristics of the migraine attack, and offering counseling assistance regarding lifestyle modification to prevent exacerbation of migraines, such as trigger avoidance and medication overuse.