Headache in children: overview and treatment approaches

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By Paul Winner DO

Headaches in childhood are increasingly being recognized as a significant neurologic health problem. The high incidence and prevalence of headaches in the pediatric population has a significant impact on children and their families. Migraine remains under-recognized, under-diagnosed, and ultimately under-treated in the this population; this has potential long-term consequences with regards to disease progression. In this clinical article, Dr. Paul Winner, of the Palm Beach Headache Center, has addressed the key issues of: (1) using practical diagnostic criteria for clinical practice, (2) which acute medication should be chosen, and (3) when to use preventive therapy in childhood. This clinical article serves as a quick reference for the diagnosis and management of primary headache disorders in children and adolescents. Effective intervention may prevent progression and lifelong consequences, including the development of comorbidities. Early diagnosis and an integrative treatment approach are essential to minimize the impact on a child's quality of life.

Key points

  • According to the American Migraine Prevalence and Prevention study (AMPP), the migraine prevalence in adolescents is 6% in the United States.
  • The first triptan to receive United States Food and Drug Administration approval for the acute treatment of adolescent migraine pain was almotriptan (12.5 mg tablet).
  • Topiramate 100 mg per day resulted in a statistically significant reduction from baseline in monthly migraine attacks.