Treatment of Pediatric Migraine

Opinion statement

The diagnosis of migraine in the pediatric population is increasing as providers are becoming more familiar with recognizing the condition. Over-the-counter and migraine-specific treatment, once considered off-label, have proven to be effective, especially if given at the early onset of head pain. Mild to severe cases of migraine should be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), with triptans used alone or in combination in moderate to severe headaches unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine (DHE), a potent vasoconstrictor should be used for intractable migraines and is preferred in the hospital setting. Anti-emetics that have anti-dopaminergic properties can be helpful in patients with associated symptoms of nausea and vomiting along with headache, especially when used in combination therapy. Preventative treatment should be initiated early in patients with frequent headaches to improve headache outcomes and quality of life. Patients and families should be educated on non-pharmacologic management, such as lifestyle modification and avoidance of triggers, that can prevent progression and worsening of migraine.

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    Conflict of Interest

    Hope L. O’Brien declares the receipt of research funding from Labry Biologics.

    Marielle A. Kabbouche is a co-investigator for GlaxoSmithKline and Merck, and a consultant for Allergan.

    Joanne Kacperski declares no conflict of interest.

    Andrew D. Hershey has received research funding from GlaxoSmithKline and Merck and is a member of the Advisory Board for MAP Pharma.

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    This article does not contain any studies with human or animal subjects performed by any of the authors.

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    Correspondence to Hope L. O’Brien MD.

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    This article is part of the Topical Collection on Headache

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    O’Brien, H.L., Kabbouche, M.A., Kacperski, J. et al. Treatment of Pediatric Migraine. Curr Treat Options Neurol 17, 1 (2015) doi:10.1007/s11940-014-0326-1

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    • Pediatric migraine
    • Primary headache
    • Treatment
    • NSAIDs
    • Triptans
    • Dopamine antagonists
    • DHE
    • Nutraceuticals
    • Headache prevention
    • Chronic migraine