Skip to main content
SpringerLink
Log in

Treatment of pediatric and adolescent headaches

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

The treatment of childhood headaches requires a thorough investigation of the underlying etiology, including the use of standardized diagnostic criteria, and neurologic and comprehensive examinations. If secondary headaches are identified, the headaches should resolve with treatment of the underlying cause. If the headaches persist or primary headaches are identified, a three-component treatment approach may need to be developed. This includes acute therapy, preventative therapy, and biobehavioral therapy. All of these components need to be addressed in the treatment of childhood headaches, and clear goals of treatment must be discussed with the patient and parents.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Bille B: Migraine in school children. Acta Paediatr 1962, 51(Suppl 136):16–151.

    Google Scholar 

  2. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988, 8(S7):l-96.

  3. Winner P, Wasiewski W, Gladstein J, Linder S: Multicenter prospective evaluation of proposed pediatric migraine revisions to the IHS criteria. Headache 1997, 37: 545–548.

    Article  PubMed  CAS  Google Scholar 

  4. Maytal J, Young M, Shechter A, Lipton RB: Pediatric migraine and the International Headache Society (IHS) criteria. Neurology 1997, 48: 602–607.

    PubMed  CAS  Google Scholar 

  5. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. Cephalagia 2004, 24(Suppl l):l-160. Essential reference for the diagnosis of headache. Serves as the basis for all current research in headache.

  6. Lewis DW, Ashwal S, Dahl G, et al.: Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002, 59: 490–498. Outlines the evidence supporting how to evaluate a child with headache.

    Article  PubMed  CAS  Google Scholar 

  7. Hershey AD, Powers SW, Vockell AL, et al.: PedMIDAS: Development of a questionnaire to assess disability of migraines in children. Neurology 2001, 57: 2034–2039.

    PubMed  CAS  Google Scholar 

  8. Hershey AD, Powers SW, Vockell AL, et al.: Development of a patient-based grading scale for PedMIDAS. Cephalalgia 2004, 24: 844–849.

    Article  PubMed  CAS  Google Scholar 

  9. Silberstein SD, Rosenberg J: Multispecialty consensus on diagnosis and treatment of headache. Neurology 2000,54: 1553. Introduces the consensus statement regarding the evidence for the evaluation and treatment of adult headache, referring to the Internet-based documents.

    PubMed  CAS  Google Scholar 

  10. Hamalainen ML, Hoppu K, Valkeila E, Santavuori P: Ibuprofen or acetaminophen for the acute treatment of migraine in children. Neurology 1997, 48: 103–107.

    PubMed  CAS  Google Scholar 

  11. Lewis DW, Kellstein D, Dahl G, et al.: Children’s ibuprofen suspension for the acute treatment of pediatric migraine. Headache 2002, 42: 780–786.

    Article  PubMed  Google Scholar 

  12. Linder SL: Subcutaneous sumatriptan in the clinical setting: the first fifty consecutive patients with acute migraine in a pediatric neurology office practice. Headache 1995, 35: 291–292.

    Google Scholar 

  13. Winner P, Prensky A, Linder S: Efficacy and Safety of Oral Sumatriptan in Adolescent Migraines. Chicago, IL: American Association for the Study of Headache; 1996.

    Google Scholar 

  14. Winner P, Rothner AD, Saper J, et al.: A randomized, double-blind, placebo-controlled study of sumatriptan nasal spray in the treatment of acute migraine in adolescents. Pediatrics 2000, 106: 989–997.

    Article  PubMed  CAS  Google Scholar 

  15. Winner P: Randomized, double-blind, placebo-controlled study of sumatriptan nasal spray in adolescent migraineurs. Neurology 2004, 62: A182.

    Article  CAS  Google Scholar 

  16. Winner P, Lewis D, Visser WH, et al.: Rizatriptan 5 mg for the acute treatment of migraine in adolescents: a randomized, double-blind, placebo-controlled study. Headache 2002, 42: 49–55.

    Article  PubMed  Google Scholar 

  17. Linder SL, Dowson AJ: Zolmitriptan provides effective migraine relief in adolescents. Int J Clin Pract 2000, 54: 466–469.

    PubMed  CAS  Google Scholar 

  18. Lipton RB, Stewart WF, Stone AM, et al.: Stratified care vs step care strategies for migraine: the Disability in Strategies of Care (DISC) study: a randomized trial. JAMA 2000, 284: 2599–2605. Develops the theory with the supporting evidence for the use of the stratified care model.

    Article  PubMed  CAS  Google Scholar 

  19. Horton BT, Peters GA, Blumenthal LS: A new product in the treatment of migraine: a preliminary report. Mayo Clin Proc 1945, 20: 241–248.

    Google Scholar 

  20. Raskin NH: Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology 1986,36: 995–957.

    PubMed  CAS  Google Scholar 

  21. Linder SL: Treatment of childhood headache with dihydroergotamine mesylate. Headache 1994, 34: 578–580.

    Article  PubMed  CAS  Google Scholar 

  22. Jones J, Sklar D, Dougherty J, White W: Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache. JAMA 1989, 261: 1174–1176.

    Article  PubMed  CAS  Google Scholar 

  23. Peroutka SJ: Dopamine and migraine. Neurology 1997, 49: 650–656.

    PubMed  CAS  Google Scholar 

  24. Kabbouche MA Vockell AL, LeCates SL, et al.: Tolerability and effectiveness of prochlorperazine for intractable migraine in children. Pediatrics 2001, 107: e62.

    Article  PubMed  CAS  Google Scholar 

  25. Burstein R, Cutrer FM: The development of cutaneous allodynia during a migraine attack: clinical evidence for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Brain 2000, 123: 1703–1709. Initial article in a growing series on the understanding of cutaneous allodynia and central sensitization.

    Article  PubMed  Google Scholar 

  26. Burstein R, Collins B, Jakubowski M: Defeating migraine pain with triptans: a race against the development of cutaneous allodynia. Ann Neurol 2004, 55: 19–26.

    Article  PubMed  CAS  Google Scholar 

  27. Burstein R, Jakubowski M: Analgesic triptan action in an animal model of intracranial pain: a race against the development of central sensitization. Ann Neurol 2004, 55: 27–36.

    Article  PubMed  CAS  Google Scholar 

  28. Mathew NT, Saper JR, Silberstein SD, et al.: Migraine prophylaxis with divalproex. Arch Neurol 1995, 52: 281–286.

    PubMed  CAS  Google Scholar 

  29. Silberstein SD: Divalproex sodium in headache: literature review and clinical guidelines. Headache 1996,36: 547–555.

    Article  PubMed  CAS  Google Scholar 

  30. Caruso JM, Brown WD, Exil G, Gascon GG: The efficacy of divalproex sodium in the prophylactic treatment of children with migraine. Headache 2000, 40: 672–676.

    Article  PubMed  CAS  Google Scholar 

  31. Serdaroglu G, Erhan E, Tekgul H, et al.: Sodium valproate prophylaxis in childhood migraine. Headache 2002, 42: 819–822.

    Article  PubMed  Google Scholar 

  32. Hershey AD, Powers SW, Vockell AL, et al.: Effectiveness of topiramate in the prevention of childhood headaches. Headache 2002, 42: 810–818.

    Article  PubMed  Google Scholar 

  33. Winner P, Pearlman E, Lindar S, et al.: Topiramate for the prevention of migraines in children and adolescence: a randomized, double-blind, placebo-controlled trial. Headache 2004, 44: 481.

    Google Scholar 

  34. Couch JR, Ziegler DK, Hassanein R: Amitriptyline in the prophylaxis of migraine. Effectiveness and relationship of antimigraine and antidepressant effects. Neurology 1976, 26: 121–127.

    PubMed  CAS  Google Scholar 

  35. Gomersall JD, Stuart A: Amitriptyline in migraine prophylaxis. J Neurol Neurosurg Psychiatr 1973, 36: 684–690.

    Article  PubMed  CAS  Google Scholar 

  36. Couch JR, Hassanein RS: Amitriptyline in migraine prophylaxis. Arch Neurol 1979, 36: 695–699.

    PubMed  CAS  Google Scholar 

  37. Levinstein B: A comparative study of cyproheptadine, amitriptyline, and propranolol in the treatment of adolescent migraine. Cephalagia 1991, 11: 122–123.

    Google Scholar 

  38. Hershey AD, Powers SW, Bentti AL, Degrauw TJ: Effectiveness of amitriptyline in the prophylactic management of childhood headaches. Headache 2000, 40: 539–549.

    Article  PubMed  CAS  Google Scholar 

  39. Bille B, Ludvigsson J, Sanner G: Prophylaxis of migraine in children. Headache 1977, 17: 61–63.

    Article  PubMed  CAS  Google Scholar 

  40. Peroutka SJ, Allen GS: The calcium antagonist properties of cyproheptadine: implications for antimigraine action. Neurology 1984, 34: 304–309.

    PubMed  CAS  Google Scholar 

  41. Ludvigsson J: Propranolol used in prophylaxis of migraine in children. Acta Neurol Scand 1974, 50: 109–115.

    Article  PubMed  CAS  Google Scholar 

  42. Ziegler DK, Hurwitz A: Propranolol and amitriptyline in prophylaxis of migraine. Arch Neurol 1993, 50: 825–830.

    PubMed  CAS  Google Scholar 

  43. Lewis D, Ashwal S, Hershey A et al.:. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology 2004, 63: 2215–2224. Reviews the evidence and provides support for the pharmacologie treatment of childhood migraine.

    PubMed  CAS  Google Scholar 

  44. Sorge F, De Simone R, Marano E, et al.: Flunarizine in prophylaxis of childhood migraine. A double-blind, placebo-controlled, crossover study. Cephalalgia 1988, 8: 1–6.

    Article  PubMed  CAS  Google Scholar 

  45. Guidetti V, Moscato D, Ottaviano S, et al.: Flunarizine and migraine in childhood. An evaluation of endocrine function. Cephalalgia 1987, 7: 263–266.

    Article  PubMed  CAS  Google Scholar 

  46. Battistella PA, Ruffilli R, Moro R, et al.: A placebo-controlled crossover trial of nimodipine in pediatric migraine. Headache 1990, 30: 264–268.

    Article  PubMed  CAS  Google Scholar 

  47. Schoenen J, Jacquy J, Lenaerts M: Effectiveness of high-dose riboflavin in migraine prophylaxis: a randomized controlled trial. Neurology 1998, 50: 466–470.

    PubMed  CAS  Google Scholar 

  48. Boehnke C, Reuter U, Flach U, et al.: High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol 2004, 11: 475–477.

    Article  PubMed  CAS  Google Scholar 

  49. Rozen TD, Oshinsky ML, Gebeline CA, et al.: Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia 2002, 22: 137–141.

    Article  PubMed  CAS  Google Scholar 

  50. Sandor PS, Di Clemente L, Coppola G, et al.: Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology 2005, 64: 713–715.

    PubMed  CAS  Google Scholar 

  51. Daly EJ, Donn PA, Galliher MJ, Zimmerman JS: Biofeedback applications to migraine and tension headaches: a double-blinded outcome study. Biofeedback Self Regul 1983, 8: 135–152.

    Article  PubMed  CAS  Google Scholar 

  52. Werder D, Sargent J: A study of childhood headache using biofeedback as a treatment alternative. Headache 1984, 24: 122–126.

    Article  PubMed  CAS  Google Scholar 

  53. Powers SW, Spirito A: Biofeedback. In Handbook of Child and Adolescent Psychiatry, vol 6. Edited by Noshpitz JD. New York: Wiley; 1998: 417–422.

    Google Scholar 

  54. Powers SW, Hershey AD: Biofeedback for childhood migraine. In Current Management in Child Neurology. Edited by Maria BL. Hamilton, Ontario: BC Decker Inc.; 2002: 83–85.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics and Children’s Hospital Medical Center, Division of Neurology, University of Cincinnati, MLC #2015, 3333 Burnet Avenue, 45229, Cincinnati, OH, USA

    Andrew D. Hershey MD, PhD

Authors
  1. Andrew D. Hershey MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hershey, A.D. Treatment of pediatric and adolescent headaches. Curr Treat Options Neurol 7, 459–467 (2005). https://doi.org/10.1007/s11940-005-0046-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-005-0046-7

Keywords

Search

Navigation