Dr. Schor of the National Institutes of Health and Deputy Director of the National Institute of Neurological Disorders and Stroke has no relevant financial relationships to disclose.)
Dr. Silberstein, Director of the Jefferson Headache Center at Thomas Jefferson University, received honorariums from Abbie, Curelator, Ipsen Therapeutics, Lundbeck Biopharmaceuticals, Supernus Pharmaceuticals, and Theranica for consulting. He is also the principal investigator for clinical trials conducted by Amgen, ElectroCore Medical, and Teva.)
This article includes discussion of headache in childhood. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
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.
• According to the American Migraine Prevalence and Prevention study (AMPP), the migraine prevalence in adolescents is 14%.
• 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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