Headache in Children and Adolescents

Christina Szperka, MD, MSCE, FAHS Headache p. 703-731 June 2021, Vol.27, No.3 doi: 10.1212/CON.0000000000000993
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PURPOSE OF REVIEW This article reviews the approach to a child or adolescent with headache, the criteria for common diagnoses, and the evidence base for treatments.

RECENT FINDINGS The guidelines for acute and preventive treatment of migraine were updated in 2019. These guidelines summarize the available evidence and outline the questions that should be addressed in future research. The US Food and Drug Administration (FDA) approval of several new classes of drugs and devices to treat adult migraine in the past few years has resulted in ongoing or planned pediatric trials.

SUMMARY Headache is a common symptom in children, and it is important to take a detailed history and perform a thorough physical examination to make the diagnosis. Nearly 1 in 10 children experience recurrent headaches due to migraine, which cause significant impairment in school performance and quality of life. The acute and preventive treatments that are currently available will help at least two-thirds of children with migraine, and several trials of new therapies offer hope for the future.

Address correspondence to Dr Christina Szperka, Division of Neurology, 3501 Civic Center Blvd, Philadelphia, PA 19104, [email protected].

RELATIONSHIP DISCLOSURE: Dr Szperka serves as an associate editor for Pain Medicine and has received research/grant support from Amgen Inc, Miles for Migraine, Pfizer Inc, the National Institutes of Health/National Institute of Neurological Disorders and Stroke (K23 NS102521), and the US Food and Drug Administration (1U18FD006298). Dr. Szperka or her institution has received compensation for her consulting work for Allergan/AbbVie Inc; Impel NeuroPharma, Inc; Lilly; Lundbeck; Teva Pharmaceutical Industries Ltd; and Upsher-Smith Laboratories, LLC.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Spzerka discusses the use of various medications and devices for the prevention of migraine in children and adolescents. The only medications approved by the US Food and Drug Administration (FDA) for migraine in children and adolescents are topiramate for prevention of migraine (ages 12+); rizatriptan (ages 6+) and almotriptan, zolmitriptan nasal, and sumatriptan/naproxen (ages 12+) for acute treatment of migraine. The external vagus nerve stimulator, remote electrical neuromodulation, and single-pulse transcranial magnetic stimulation devices are FDA cleared for use in adolescents. All other medications and devices discussed in this article are unlabeled/investigational in children and adolescents.

© 2021 American Academy of Neurology.