The treatment of pediatric migraine.
The management of pediatric migraine requires a balance of biobehavioral measures coupled with agents for acute treatment and, if needed, daily preventive medicines. A recent American Academy of Neurology practice parameter has critically reviewed the limited data regarding the efficacy and safety of medicines for the acute and preventive therapy of pediatric migraine. The first step is to establish the headache frequency and degree to which the migraines impact upon lifestyle and performance. The next step is to institute nonpharmacologic measures such as regulation of sleep (improved sleep hygiene), moderation of caffeine, regular exercise, and identification of provocative influences (eg, stress, foods, social pressures). A wide variety of therapeutic options exist for patients whose migraine headaches occur with sufficient frequency and severity to produce functional impairment. The most rigorously studied agents for the acute treatment of migraine are ibuprofen, acetaminophen, and sumatriptan nasal spray, all of which have shown safety and efficacy in controlled trials. Daily preventive drug therapies are warranted in about 20% to 30% of young migraine sufferers. The particular drug selected for the individual patient requires an appreciation of comorbidities such as affective or anxiety disorders, co-existent medical conditions such as asthma or diabetes, and acceptability of potential toxicities such as weight gain, sedation, or tremor.
Lewis
Donald W
DW
Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, VA, USA. dlewis@chkd.com
Yonker
Marcy
M
Winner
Paul
P
Sowell
Michael
M
D000319:Adrenergic beta-Antagonists; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002648:Child; D000529:Complementary Therapies; D000075202:Contraindications; D003533:Cyproheptadine / Q000627:therapeutic use; D004032:Diet; D004876:Ergot Alkaloids / Q000627:therapeutic use; D006801:Humans; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D020326:Migraine without Aura / Q000175:diagnosis / Q000628:therapy; D023303:Oxazolidinones / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D018170:Sumatriptan / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D014363:Tryptamines
D000319:Adrenergic beta-Antagonists; D000927:Anticonvulsants; D000928:Antidepressive Agents; D000932:Antiemetics; D002121:Calcium Channel Blockers; D004876:Ergot Alkaloids; D023303:Oxazolidinones; D017366:Serotonin Receptor Agonists; D014230:Triazoles; D014363:Tryptamines; C089750:zolmitriptan; D003533:Cyproheptadine; C093622:rizatriptan; D018170:Sumatriptan