It is clear that childhood and pediatric migraine do not get sufficient
notice from pediatricians. If a child is missing school or social events
because of recurrent headaches, then they should be addressed. There
is a general belief that migraine in children are rare when they are
not.
Unfortunately, in many cases, even when migraines in children are recognized,
they are commonly undertreated in a manner similar to adults.
Childhood migraines typically occur in a setting where another member
of the family has migraines. As a rule of thumb, 3/4th of children with
migraine have family members with migraine. Conversely, if one parent
has migraine, about 1/2 of their children will have migraine (higher
for
dads than mom) and if both parents have migraine then it is estimated
that about 2/3rds of children will have migraine.
One population study by Abu-Arefeh (BMJ 1994; 309; 765-9) demonstrated
the migraine incidence in school children between the age of 5-15 was
10.6%. The incidence was higher after age 10 and peaked at 27% of girls
at age 14 and 20% of boys at age 12.
Notes to the I.H.S. criteria for migraine include a notice that childhood
migraines may last as short as one hour. In addition they are more commonly
bilateral. Photophobia and phonophobia may be inferred from their behavior.
In addition, occipital pain in children is rare and usually leads to further
evaluation.
Head to head studies between ibuprofen and tylenol shows the superiority
of ibuprofen. Triptans are not currently approved for migraine in children
but are commonly used by neurologists despite this for refractory cases.
No prevention medications are approved in children but the medications
used are typically the same as adults.
Children sometimes get migraine precursors that include cyclic vomiting,
cyclic abdominal pain, and cyclic vertigo. The discussion of these diagnosis
is beyond the scope of this web site.
Dr. Loftus will commonly treat children in his practice for migraines
as young as age 13 if there are no additional neurological issues.
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