Migraine

Question 1

What is the International Headache Society Criteria for diagnosing migraines without aura in children and adolescents?

Answer 1

at least five headaches of 1–72h, with at least two of the following:

• unilateral or bilateral pain
• throbbing pain
• moderate or severe pain
• pain aggravated by routine physical activity.

and at least one of the following:

• nausea/vomiting
• photophobia/phonophobia

Question 2

What are the treatment options available for migraines in children and paediatrics?

Answer 2

• exclusion of triggers (diet, dehydration, tiredness, and stress)
• acute treatment choices include ibuprofen, nasal sumatriptan/zolmitriptan, and PO rizatriptan.
• antiemetics can also be helpful
• prophylaxis: if the migraine is frequent enough to disrupt activity, consider prophylaxis, e.g. topiramate, propranolol, and flunarizine.

Question 3

What is the first line management for migraine in a child?

Answer 3

Simple analgesia (paracetamol or ibuprofen)

Question 4

What is the second line management for migraine in a child?

Answer 4

Nasal sumatriptan (if 12+ years)

Question 5

What is the third line management for migraine in a child?

Answer 5

Combination therapy with nasal triptan and NSAID/paracetamol