Paediatrics: Headache: migraine

Headache: migraine

Up to 10% of children may have migraine. These are debilitating episodes and the criteria are listed below. If they occur frequently (more than 4 times per month for more than 3mths), the diagnosis is unlikely. If the headache occurs daily then the term chronic headache should be used and managed.

Treatment

·  Exclude triggers: such as diet, dehydration, overtiredness, and stress.

·  Paracetamol and domperidone: these can be tried initially, at the onset of symptoms, as they will treat the headache and nausea.

·  Prophylaxis: if the migraine is frequent enough to disrupt schooling or social activity, then consider prophylaxis. The evidence-base for different therapies is poor. Initially try a 3mths trial of pizotifen. If this is not effective, then try propranolol. Antidepressants such as amitriptyline have also been used. Sumatriptan may be used in children older than 12yrs at the onset of symptoms, if other treatments are ineffective.

Diagnostic criteria for paediatric migraine

Migraine without aura

A At least 5 attacks fulfilling B–D

B Headache attack lasting 1–48hr

C Headache has at least two of the following:

·  Bilateral (temporal or frontal) or unilateral location

·  Pulsating quality

·  Moderate to severe intensity

·  Aggravation by routine physical activity

·  Nausea and/or vomiting

• Photophobia and/or phonophobia

Migraine with aura

A Idiopathic recurring disorder: headache that usually lasts 1–48hr

·  At least two attacks fulfilling C C At least three of the following:

• One or more fully reversible aura symptoms indicating focal cortical and/or brainstem dysfunction

• At least one aura developing gradually over >4min, or two or more symptoms occurring in succession

• No aura lasting >60min

• Headache follows in <60min