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 Alder Biopharmaceuticals, Allergan, Amgen, Avanir Pharmaceuticals, Curelator, Depomed, Dr. Reddy's Laboratories, eNeura, electroCore Medical, Lilly USA, Supernus Pharmacerticals, Teva, and Trigemina for consulting and/or advisory panel membership.)
Originally released March 15, 2010; last updated October 23, 2016; expires October 23, 2019

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, and (3) when to use preventive therapy in childhood. 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).

 

Topiramate 100 mg per day resulted in a statistically significant reduction from baseline in monthly migraine attacks.

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