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: 1.4). 06/2009; 27(2):481-501. DOI: 10.1016/j.ncl.2008.11.003
Source: PubMed


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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    • "Headache is one of the most common problems worldwide, and migraines represent a significant proportion of primary headaches. In childhood, migraine causes frequent, chronic, progressive, and recurring headache (1). There has been a significant increase in the prevalence of migraine in children over the last 20 years. "
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    ABSTRACT: The purpose of this study was to investigate the effect of supplementary vitamin D therapy in addition to amitriptyline on the frequency of migraine attacks in pediatric migraine patients. Fifty-three children 8-16 years of age and diagnosed with migraine following the International Headache Society 2005 definition, which includes childhood criteria, were enrolled. Patients were classified into four groups on the basis of their 25-hydroxyvitamin D [25(OH)D] levels. Group 1 had normal 25(OH)D levels and received amitriptyline therapy alone; group 2 had normal 25(OH)D levels and received vitamin D supplementation (400 IU/day) plus amitriptyline; group 3 had mildly deficient 25(OH)D levels and received amitriptyline plus vitamin D (800 IU/day); and group 4 had severely deficient 25(OH)D levels and was given amitriptyline plus vitamin D (5000 IU/day). All groups were monitored for 6 months, and the number of migraine attacks before and during treatment was determined. Calcium, phosphorus alkaline phosphatase, parathormone, and 25(OH)D levels were also determined before and during treatment. Results were compared between the groups. Data obtained from the groups were analyzed using one-way analysis of variance. The number of pretreatment attacks in groups 1 to 4 was 7±0.12, 6.8±0.2, 7.3±0.4, and 7.2±0.3 for 6 months, respectively (all P>0.05). The number of attacks during treatment was 3±0.25, 1.76±0.37 (P<0.05), 2.14±0.29 (P<0.05), and 1.15±0.15 (P<0.05), respectively. No statistically significant differences in calcium, phosphorus, alkaline phosphatase, or parathormone levels were observed (P>0.05). Vitamin D given in addition to anti-migraine treatment reduced the number of migraine attacks.
    Full-text · Article · Apr 2014 · Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.]
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    • "formulations of selective serotonin receptor agonists were not beneficial in children. Zolmitriptan nasal spray (2.5 to 5 mg), demonstrated efficacy when evaluated in 12-to 17-year-old children (Lewis et al., 2007). Lewis and colleagues' practice parameters (2004) addressed the limitations of pharmacologic agents, reporting inconclusive data regarding preventive treatment of migraine headaches. "
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    ABSTRACT: Abdominal migraine affects 1% to 4% of children and is a variant of migraine headaches. Onset is seen most often between the ages of 7 to 12 years, with girls affected more often than boys. Presenting symptoms include acute incapacitating non-colicky periumbilical abdominal pain that lasts for 1 or more hours. Pallor, anorexia, nausea, vomiting, photophobia, or headache may be associated with the episodes, and a family history of migraine headaches often is noted. The diagnostic process begins with a thorough history and physical examination and often follows a series of exclusions or elimination of other organic causes. Limited research exists regarding treatment options, but they may include pharmacologic intervention and prevention based on lifestyle modifications.
    Preview · Article · Nov 2010 · Journal of Pediatric Health Care
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    • "Open-label and retrospective studies [1, 10] have suggested that valproic acid may be effective in the prevention of migraine in children and adolescents. "
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    ABSTRACT: There is a serious lack of controlled studies on the pharmacological treatment of primary migraine in the developmental age; there is, consequently, an urgent need for new, evidence-based approaches to this long-neglected field of research. Moreover, previous studies have stated that the placebo response is greater in pediatric patients than in adults and that a reduction in the attack frequency in the absence of any pharmacological treatment is observed more frequently in pediatric migraine patients than in adults. Besides these preliminary considerations, the shorter duration of migraine attacks and other characteristic semeiological features of the clinical picture in children are such that the design of randomized controlled trial (RCT) is more problematic in the developmental age than in the adult. Bearing in mind all these weak points, the aim of this review was to summarize and update recent guidelines for the treatment of primary migraine in children and adolescents. The most recent guidelines are those published by the Italian Society for the study of Headache, the French Society for the study of Migraine and Headache, and the American Academy of Neurology. We have incorporated into these guidelines the results from the few, recent RCTs, clinical controlled trials, open-label studies, meta-analyses and reviews that have been published since 2004; owing to the lack of strong evidence in this field of research, we have sometimes even mentioned pilot non-controlled studies, case series and expert opinions. Lastly, evidence was classified and the recommendations were categorized according to different levels.
    Full-text · Article · Mar 2010 · The Journal of Headache and Pain
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