Guidelines: acute and preventive paediatric migraine treatment

Takeaway

• These authors provide a synopsis of treatment and prevention guidelines for paediatric migraine.
• They also note that the emphasis on lifestyle interventions has less of an evidence base than the pharmacologic recommendations and that lifestyle-related recommendations risk creating stress for families.

Why this matters

• With almost 1 in 10 children having migraines, prevention and treatment are crucial.
• These recommendations are for treating children and adolescents with migraine.
• Target population: children and adolescents with migraine.

Key recommendations

• Take a detailed history and make the diagnosis specific.
• Advise treatment early in an acute attack.
• Ibuprofen is appropriate for pain in children and adolescents, and a triptan or triptan/naproxen combination is appropriate in adolescents.
• If triptan fails, try the combination with NSAID.
• If pain increases anyway, try a nonoral triptan.
• Also try nonoral triptans with nausea and vomiting, or try an antiemetic.
• Triptans are OK in migraine with aura but to be avoided with cardiovascular disease, accessory conduction pathway disorders.
• For prevention, discuss amitriptyline costs and benefits in combination with behavioral therapy, topiramate, propranolol, including teratogen-related risks requiring use of birth control and folate supplementation.