Headache in children: overview and treatment approaches

Nina Schor MD PhD (Dr. Schor of the University of Rochester Medical Center and Chair of the Department of Pediatrics at Golisano Children’s Hospital at Strong has no relevant financial relationships to disclose.)
Stephen D Silberstein MD, editor. (Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, receives honorariums from Allergan, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura,  INSYS Therapeutics, Lilly USA, Supernus Pharmacerticals,  Thernica and Trigemina for consulting. He is also the  principal investigator for a clinical trials conducted by Alder Biopharmaceuticals, Amgen, electroCore Medical, Lily USA and Teva.)
Originally released March 15, 2010; last updated May 10, 2017; expires May 10, 2020

This article includes discussion of headache in childhood. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Primary headaches, particularly those that are recurrent or chronic, in childhood are increasingly being recognized as a significant neurologic health problem. The high incidence and prevalence of headaches in the pediatric population has a significant impact on children and their families. Migraine remains under-recognized, under-diagnosed, and ultimately under- or inappropriately treated in this population; this has potential long-term consequences with regards to disease progression. The author has addressed the key issues of: (1) using practical diagnostic criteria for clinical practice, (2) which acute medication should be chosen, (3) when to use preventive therapy in childhood, and (4) which preventive therapies have the best therapeutic index. This article serves as a quick reference for the diagnosis and management of primary headache disorders in children and adolescents. Effective intervention may prevent progression and lifelong consequences, including the development of comorbidities. Early diagnosis and an integrative treatment approach are essential to minimize the impact on a child's quality of life.

Key points

 

• According to the American Migraine Prevalence and Prevention study (AMPP), the migraine prevalence in adolescents is 6% in the United States.

 

• The first triptan to receive United States Food and Drug Administration approval for the acute treatment of adolescent migraine pain was almotriptan (12.5 mg tablet).

 

• Amitriptyline (1 mg per kilogram of body weight per day), topiramate (2 mg per kilogram per day), and placebo had equivalent (50% to 60%) efficacy in reduction of headache frequency by 50% in children and adolescents 8 to 17 years of age with migraine.

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