management of childhood migraine

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  • assessment of headache and diagnosis of migraine
  • 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
    • if a child has frequent or severe migraine attacks then prophylaxis with pizotifen or propranolol is often given - however the evidence to justify this is weak (1)

Reference:

  1. Drug and Therapeutics Bulletin (2004), 42 (4), 25-8.

Last reviewed 11/2020

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