Diagnosis and Treatment of Childhood Migraine

Abstract

While the diagnosis of migraine in children is generally straightforward, treatment can seem complex with a number of medication choices, many of which are used "off label." Patients with intermittent migraines can often be managed with ibuprofen or naproxen taken as needed. Unfortunately, by the time that children present to our practice, they have often tried these medications without improvement. Triptans are frequently prescribed to these patients with good success. It is important to make the patient aware of the possible associated serotonergic reactions. If the patient is having more than one headache per week or the headaches are prolonged, prophylactic treatment is indicated. In our practice, the overwhelming majority of these patients will be treated with amitriptyline or topiramate. We generally allow side effect tolerability to guide our choice of medication. Cyproheptadine is often used in younger patients as it comes in a liquid form. There is evidence supporting the use of propranolol, though the potential worsening of underlying asthma symptoms may limit its use, and sodium valproate, which must be used with caution in female patients of childbearing age due to significant teratogenicity risks. Other prophylactic treatments with less robust evidence include the antiepileptic drugs gabapentin, zonisamide, and levetiracetam; calcium channel blockers such as verapamil and amlodipine; and the angiotensin receptor blocking agent candasartin (not available in the USA). Almost all patients in our practice are advised to take magnesium supplementation. Magnesium is a supplement with relatively few adverse effects and good evidence for improvement of migraine symptoms. We evaluate lifestyle issues and comorbidities in all our patients. Ignoring these will make successful treatment near impossible. Good sleep, adequate hydration, appropriate diet, and exercise are vitally important. Finally, most of our patients benefit from a psychology evaluation with cognitive behavioral therapy. Stress management and biofeedback are tremendously helpful in improving quality of life in migraineurs.

Antihypertensive agents: a long way to safe drug prescribing in children

“…Data for propranolol, atenolol, and carvedilol in children is primarily available for varying indications such as portal hypertension, congestive heart failure, migraines, and arrhythmias, suggesting efficacy with an acceptable safety profile [110][111][112][113]. Minimal studies, however, have examined their use in HTN.…”

An Improved Lc-MS/MS Method Development and Validation for the Determination of Trandolapril and Verapamil in Human Plasma

“…Literature survey of TDL and VPL revealed that several analytical techniques were employed such as high-performance thin layer chromatography (HPTLC) [7], high-performance liquid chromatography (HPLC) [8-12] and LC-MS/MS [13,14]. Aim of the present work was to develop an improved, accurate and rapid LC-MS/MS technique with low retention time.…”

The efficacy and safety of levetiracetam in the prophylaxis of migraine headaches in children – a randomised trial

“…In addition, these headaches have a severe impact on different aspects of quality of life of children and their families. Therefore, effective management of these headaches is required [1][2][3].…”