Pediatric and Adolescent Headache

Amy A. Gelfand, MD Headache p. 1108-1136 August 2018, Vol.24, No.4 doi: 10.1212/CON.0000000000000638
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PURPOSE OF REVIEW: This article provides the practicing neurologist with a comprehensive, evidence-based approach to the diagnosis and management of headache in children and adolescents, with a focus on migraine.

RECENT FINDINGS: Four triptans are now labeled by the US Food and Drug Administration (FDA) for acute migraine treatment in adolescents, and rizatriptan is labeled for use in children age 6 and older. For preventive migraine treatment, the Childhood and Adolescent Migraine Prevention trial demonstrated that approximately 60% of children and adolescents with migraine will improve with a three-pronged treatment approach that includes: (1) lifestyle management counseling (on sleep, exercise, hydration, caffeine, and avoidance of meal skipping); (2) optimally dosed acute therapy, specifically nonsteroidal anti-inflammatory drugs and triptans; and (3) a preventive treatment that has some evidence for efficacy. For the remaining 40% of children and adolescents, and for those who would not have qualified for the Childhood and Adolescent Migraine Prevention trial because of having continuous headache or medication-overuse headache, the clinician’s judgment remains the best guide to preventive therapy selection.

SUMMARY: Randomized placebo-controlled trials have been conducted to guide first-line acute and preventive migraine treatments in children and adolescents. Future research is needed to guide treatment for those with more refractory migraine, as well as for children and adolescents who have other primary headache disorders.

Address correspondence to Dr Amy A. Gelfand, University of California, San Francisco, Department of Pediatrics, 550 16th St, 4th floor, Box 0137, San Francisco, CA 94158, amy.gelfand@ucsf.edu.

RELATIONSHIP DISCLOSURE: Dr Gelfand has received personal compensation for serving on the medical advisory board of eNeura Inc; as associate editor for JAMA Neurology; and as a consultant for Biohaven Pharmaceutical, Eli Lilly and Company, and Zosano Pharma Corporation. Continued on page 1136Dr Gelfand has received research/grant support from eNeura Inc, the Migraine Research Foundation, the National Institutes of Health/National Center for Advancing Translational Sciences, and the University of California San Francisco Weill Institute for the Neurosciences. Dr Gelfand has received publishing royalties from UpToDate, Inc and has received compensation as a legal consultant.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Gelfand discusses the unlabeled/investigational use of all listed medications for the treatment of headache in children and adolescents, with the exceptions of almotriptan oral tablets, sumatriptan/naproxen combination tablets, and zolmitriptan nasal spray for adolescents 12 to 17 years of age for the treatment of acute migraine as well as topiramate in adolescents 12 to 17 years of age for migraine prevention. Rizatriptan is labeled for acute migraine treatment in children age 6 and older.

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© 2018 American Academy of Neurology