Diagnostic criteria and approaches to the treatment of migraine in children

Treatment of patients with migraine should be aimed at the rapid and complete elimination of headache with minimal side effects.

In adults, as in children and adolescents, the criterion for effective early treatment of migraine is symptom relief within less than 1 hour of headache onset.

Find out in the article on estet-portal.com about the features of the clinical picture, diagnostic criteria and methods of treating migraine in children.

• Diagnostic criteria for migraine in children
• Approaches to the treatment of migraine in children
• Peculiarities of prescribing drugs for migraine in children
• Contraindications for the use of triptans for the treatment of migraine in children Diagnostic criteria for migraine in children Auras typically occur in about a third of older children and adolescents and precede the onset of a headache by 5-60 minutes. Follow us on Instagram

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Criteria for staging migraine in children include the following parameters: At least 5 episodes of headache within the last year lasting 2-72 hours without any type of treatment; 2 of the following headache signs are identified:

pulsating;

one-sided;
worsens during activity;
moderate or severe intensity.

Headache associated with nausea, vomiting, photo- or phonophobia
her.

Botulinum toxin in the treatment of migraine

3. Approaches to the treatment of migraine in children

Many children and adolescents benefit from the use of

oral analgesics such as paracetamol, ibuprofen and naproxen. Triptans are less often given to children than adults.

The Food and Drug Administration (FDA) has approved the following

medicines for the treatment of migraine in children

:

almotriptan − from 12 years old;

rizatriptan − 6 to 17 years old; sumatriptan / naproxen − from 12 years old;

zolmitriptan − 12 years and older.

It is recommended to take the prescribed medication as soon as possible when a migraine attack occurs.

• Oral
ibuprofen solution
• at a dose of 10 mg/kg body weight is recommended as an initial treatment option for migraine in children.

Recommended

duration of use of medicines

in the treatment of migraine in children:

ibuprofen or paracetamol − no more than 14 days per month;

Peculiarities of prescribing drugs for migraine in children In adult patients, the lack of response (response) to treatment with one of the triptans does not exclude a positive reaction to

an alternative drug

from this group.
Also, if on the one hand a positive reaction to the prescribed triptan is determined, and on the other − recurrent headache occurs within 24 hours, then
• repeated use
of the drug is effective.
• This tactic is also allowed for the treatment of migraine in children, but the maximum daily dose
of prescribed medications must be taken into account.

New possibilities for medical treatment of migraine

Intranasal sumatriptan and

zolmitriptan

are absorbed faster and therefore act faster than the oral form. For patients with severe migraine accompanied by nausea and vomiting,

parenteral formulations

are more effective in relieving symptoms. Re-use of the drug is recommended if the child or adolescent has a recurrent headache within 24 hours. Adolescents who do not respond (react) to a prescribed triptan should add ibuprofen or naproxen to the triptan.

In adults, the use of sumatriptan/naproxen combination (10/60, 30/180 and 85/500 mg tablets) is more effective than monotherapy. It is recommended that adolescents with migraine be advised that triptans are safe to take for typical auras, but that the drug is more effective when given at the onset of the headache and before the aura begins.

After the use of zolmitriptan (nasal spray) and sumatriptan / naproxen, photophobia and phonophobia have disappeared, but none of the drugs that are prescribed to patients with migraine are effective against nausea or vomiting. 

Light Head or Botulinum Therapy for Migraine

There are no studies evaluating antiemetics in children with migraine, but in practice they are added to treatment to eliminate nausea and vomiting, as well as accelerate the absorption of drugs

Children and adolescents who suffer from migraine, as well as their families, should be consulted to:

prevention of overuse of medicines; Identification and elimination of factors that cause migraine;

lifestyle modifications.

Children and adolescents with migraine are advised to keep a

"headache diary"

to monitor reactions to prescribed medication.

Botulinum toxin in the treatment of chronic pain
According to the FDA,
• triptans are contraindicated in
patients who have a history of:

stroke;

transient ischemic attack;

myocardial infarction; Prinzmetal's angina;

severe peripheral vascular disease;

Ischemic bowel disease.

These drugs are also contraindicated in patients with disorders of the conduction tracts of the heart, Wolff-Parkinson-White syndrome.
The medical contraindications listed are less common in the pediatric population, but it is important to consider them when prescribing drugs for the treatment of migraine in children.
 
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