Особенности клинической картины и медикаментозного лечения мигрени у детей

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 of effective early treatment of migraine is the relief of symptoms within less than 1 hour from the onset of headache.

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

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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:

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    3. pulsating;

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

    • Headache associated with nausea, vomiting, photo- or phonophobia
  • her.
  • Approaches to the treatment of migraine in children
Many children and adolescents benefit from pain relief when 
    oral analgesics
  1. such as paracetamol, ibuprofen and naproxen. Triptans are prescribed less often to children than to 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.
  • As an initial treatment option for migraine in children, it is recommended to administer an oral ibuprofen solution
    •  at a dose of 10 mg/kg of body weight.
Recommended 
Duration of Medications
 For the treatment of migraine in children:

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

triptans − no more than 9 days per month;

My default imageany combination of triptans, analgesics − no more than 9 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 in the treatment of migraine in children, but must be taken into accountdaily maximum dose prescribed drugs.

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Intranasal sumatriptan and zolmitriptan

 are absorbed faster and therefore act faster than the oral form.

In patients with severe migraine accompanied by nausea and vomiting, parenteral administration is 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

 (tablets at doses of 10/60, 30/180 and 85/500 mg) 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. 

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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

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Contraindications for the use of triptans for the treatment of migraine in childrenMy default image

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 may be advised to keep a "headache diary" to monitor responses to treatment.

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    • 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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