Article

Pediatric migraine

Department of Pediatrics, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, 601 Children's Lane, Norfolk, VA 23507, USA.
Neurologic Clinics (Impact Factor: 1.61). 06/2009; 27(2):481-501. DOI: 10.1016/j.ncl.2008.11.003
Source: PubMed

ABSTRACT Migraine headaches are common in children and adolescents, with a wide spectrum of clinical forms. The most frequent pattern in children is migraine without aura, characterized by attacks of frontal, pounding, nauseating headache lasting 1 to 72 hours. The spectrum of migraine with aura includes migraine with typical aura, hemiplegic migraine, and basilar-type migraine, all of which may manifest during early childhood and pose challenging diagnostic dilemmas. The periodic syndromes are a fascinating subset of migraine peculiar to extremely young children, which are viewed as "precursors" to more typical migraine and can be associated with frightening focal neurologic disturbances. Migraine treatment philosophy now embraces a balanced approach with biobehavioral interventions and acute and preventative pharmacologic measures. A growing body of controlled pediatric data is beginning to emerge regarding migraine treatment in children, lessening our dependence on extrapolated adult data.

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  • Pediatric Neurology 10/2014; 51(4). DOI:10.1016/j.pediatrneurol.2014.07.002 · 1.50 Impact Factor
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    ABSTRACT: Migraine headache is a common pediatric complaint among emergency department (ED) patients. There are limited trials on abortive therapies in the ED. The objective of this study was to apply a comparative effectiveness approach to investigate acute medication regimens for the prevention of ED revisits. Retrospective study using administrative data (Pediatric Health Information System) from 35 pediatric EDs (2009-2012). Children aged 7 to 18 years with a principal diagnosis of migraine headache were studied. The primary outcome was a revisit to the ED within 3 days for discharged patients. The primary analysis compared the treatment regimens and individual medications on the risk for revisit. The study identified 32 124 children with migraine; 27 317 (85%) were discharged, and 5.5% had a return ED visit within 3 days. At the index visit, the most common medications included nonopioid analgesics (66%), dopamine antagonists (50%), diphenhydramine (33%), and ondansetron (21%). Triptans and opiate medications were administered infrequently (3% each). Children receiving metoclopramide had a 31% increased odds for an ED revisit within 3 days compared with prochlorperazine. Diphenhydramine with dopamine antagonists was associated with 27% increased odds of an ED revisit compared with dopamine antagonists alone. Children receiving ondansetron had similar revisit rates to those receiving dopamine antagonists. The majority of children with migraines are successfully discharged from the ED and only 1 in 18 required a revisit within 3 days. Prochlorperazine appears to be superior to metoclopramide in preventing a revisit, and diphenhydramine use is associated with increased rates of return. Copyright © 2015 by the American Academy of Pediatrics.
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    ABSTRACT: Objective Migraine affects approximately 4-11% of elementary school children, yet reaching a diagnosis in this age group can be challenging. The goal of this study was to develop a screening migraine questionnaire that could be easily implemented by a General Pediatrician, and validate its use in diagnosing migraine in children 5-12 years old. Methods A questionnaire, the McMaster Migraine Tool, was developed using the International Classification of Headache Disorders-II criteria for migraine. The validity of the questionnaire was assessed by comparing the diagnosis based on the results of the questionnaire compared to the diagnosis made by a Pediatric Neurologist. Results The questionnaire was used to assess a cohort of 69 children referred to the Pediatric Neurology clinic for headache. The sensitivity and specificity of the McMaster Migraine Tool were determined to be 84% and 69% respectively. Families graded its ease of use to be 9/10 (10 being easy to use). Conclusion The McMaster Migraine Tool may be useful in diagnosing migraine in 5-12 year old children, as it is readily completed and regarded as easy to use. Application of this tool could lead to expedited diagnosis and management of migraine.
    Pediatric Neurology 09/2014; 52(2). DOI:10.1016/j.pediatrneurol.2014.09.011 · 1.50 Impact Factor

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