Migraine Headache in Children (cont.)

Medical treatment of migraine headaches in children is based on the following: (1) education of children and parents or caregivers about migraine triggers, (2) creation of a plan of immediate treatment for the attacks, and (3) consideration of preventive medicines or measures for children with frequent migraines.

The doctor should explain the disease to the child and the parents or caregivers. The treatment of children with mild, infrequent migraine attacks consists mainly of rest, trigger avoidance, and stress reduction.

The doctor should also assure parents that the headache is not caused by a brain tumor or other life-threatening condition. A regular bedtime, strict meal schedules, and not overloading the child with too many activities are important. Helping the child recognize migraine triggers is helpful but often difficult. Ridding migraine triggers reduces the frequency of headaches in some children but does not completely stop occurrences.

A headache diary can be used to record triggers and features of attacks. Triggering factors that occur up to 12 hours prior to an attack should be noted. Other important factors to include are as follows:

• Date and time the attack began
• Type and location of headache pain
• Symptoms before the headache
• All food and drink consumed prior to the attack
• Bedtime, wake time, and quality of sleep prior to the attack
• Menstrual periods (if applicable)
• Activities before the headache
began
• Medications taken and their side effects

Unfortunately, even the most diligent person cannot always identify specific migraine triggers.

At the time of attack, parents or caregivers should have the child lie down in a cool, dark, quiet room to help him or her fall asleep. In spite of the development of many effective anti-migraine medications, sleep is the most powerful and best treatment. During a migrainous attack, a child can often be found resting in the fetal position with the affected side of the head down.

Some children find that ice or pressure on the affected artery can reduce pain for a short time. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective if taken at a high but appropriate dose during the aura or early headache phase. Common over-the-counter (OTC) NSAIDs include ibuprofen (Advil, Children's Advil/Motrin, etc.) and naproxen (Aleve, Naprosyn, Anaprox, Naprelan). Acetaminophen (Tylenol and others) may also be used for pain control. Aspirin should not be used in children or adolescents.

Digestion temporarily slows or stops during migraine attacks, delaying absorption of oral medications. Occasionally, carbonated beverages may improve absorption. Other treatment methods, such as self-relaxation, biofeedback, and self-hypnosis, may be reasonable alternatives to drug therapies in childhood migraine, particularly in adolescents. Response rates in children tend to be higher than in adults and show continued effectiveness over time.

The primary goals of preventive therapy are to prevent migraine attacks and to reduce the frequency and severity of attacks. Most preventive migraine medications have potential side effects, so only children with at least one to two attacks per week should take them. Parents and caregivers should have realistic expectations. While medications lessen the impact of migraines, they do not resolve the underlying causes and they will not completely eliminate all migraines. Half of all patients experience a 50% reduction in migraines (at most).