Management of Migraine and Other Headaches

Abstract

Headache is a common symptom in childhood and adolescence. Primary headaches, including migraine and tension-type, are most frequent, especially in adolescence, often occur together in an individual, and are readily differentiated from secondary headaches (such as traumatic, neoplastic, or infectious headache) by history and targeted physical examination. A prompt and definitive diagnosis of a primary headache disorder facilitates effective treatment. Migraine variants and “periodic syndromes” are more likely in children, including paroxysmal torticollis and vertigo, cyclic vomiting syndrome and abdominal migraine, and confusional migraine. A rare genetic syndrome, familial hemiplegic migraine, is associated with a neuronal channel defect, suggesting a role for sodium and calcium channel dysfunction in the pathophysiology of some migraine presentations. Chronic daily headache and analgesic overuse headache are increasingly recognized in pediatrics.

Treatment of all primary headaches include both pharmacologic and nonpharmacologic modalities, including education, lifestyle modification, cognitive-biobehavioral therapy, and adjustment of unrealistic expectations. Reports of controlled clinical trials have increased the choice of treatments for acute and chronic headaches in pediatrics. However, drug therapy for pediatric headaches remains primarily based on adult studies.