initial management should address any underlying concerns of the child and parents/carers
self-help strategies may help in the prevention of attacks e.g. minimising or avoiding stress, having regular bedtimes and mealtimes and sufficient (not excessive) sleep
behavioural interventions such as thermal biofeedback and progressive muscle relaxation - these interventions may help but this needs confirmation with appropriate studies
acute treatment of migraine
for the acute treatment of headaches then paracetamol or ibuprofen is usually sufficient, combined with an antiemetics (e.g. domperidone) if vomiting is a problem
evidence relating to the use of nasal sumatriptan at the licensed dose to relieve migraine in those aged 12-17 years is weak (1)
prohylaxis
with respect to migraine prophylaxis in children a review states (2):
propranolol was found to be possibly effective in reducing migraine frequency by 50% compared with placebo
topiramate and cinnarizine (not available in the US or Canada) were possibly associated with reduced frequency of headache compared with placebo
Reference:
Drug and Therapeutics Bulletin (2004), 42 (4), 25-8.
Hovaguimian A, Roth J. Management of chronic migraine BMJ 2022; 379 :e067670 doi:10.1136/bmj-2021-067670
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