Recommendations for the management of migraine in paediatric patients.
Migraine is a common and disabling condition in children and adolescents. The complexity of migraine on a pathogenetic and clinical level results from the interaction between biological, psychological and environmental factors. Appropriate management requires an individually tailored strategy giving due consideration to both pharmacological and non-pharmacological measures. Ibuprofen (7.5-10.0 mg/kg) and acetaminophen (15 mg/kg) are safe and effective, and should be considered for symptomatic treatment. Sumatriptan nasal spray (5 and 20 mg) is also likely to be effective, but at the moment, should be considered for the treatment of adolescents only. With reference to prophylactic drug treatment, the available data suggest that flunarizine (5 mg/day) is likely to be effective and pizotifen and clonidine are likely to be ineffective. The efficacy data regarding propranolol, nimodipine and trazodone are conflicting. Insufficient evidence is available on cyproheptadine, amitriptyline, divalproex sodium, topiramate, levetiracetam, gabapentin or zonisamide. The management of migraine in children needs an individualised therapeutic approach, directed to the whole person of the child, taking into account the developmental perspective and the high rate of psychiatric comorbidities. It is the authors' opinion that for the prophylaxis of migraine, interventions such as identification and avoidance of trigger factors, regulation of lifestyle, relaxation, biofeedback, cognitive behavioural treatment and psychological or psychotherapeutic interventions (e.g., psychodynamics) could be much more effective than pharmacotherapy.
Balottin
Umberto
U
Child Neuropsychiatry Unit, Department of Clinical and Biological Sciences, University of Insubria and Macchi Foundation Hospital, Varese, p.zza Biroldi, 19, 21100 Varese, Italy. umberto.balottin@uninsubria.it
Termine
Cristiano
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D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002986:Clinical Trials as Topic; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D011613:Psychotherapy; D018490:Serotonin Agents / Q000008:administration & dosage / Q000627:therapeutic use; D012737:Sex Factors; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000928:Antidepressive Agents; D000959:Antihypertensive Agents; D003278:Contraceptives, Oral, Hormonal; D018490:Serotonin Agents