Pediatric emergency medicine trisk 2619 2619
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DISORDERS THAT PRESENT WITH HEADACHE (SEE ALSO
CHAPTER 59 PAIN: HEADACHE )
Migraine
Goals of Treatment
For children with a known diagnosis of migraine, acute management is aimed at
reduction of symptoms (which may include nausea and vomiting as well as pain)
to a point where home management is feasible. When a diagnosis of migraine has
not been established, the emergency clinician must also evaluate for other
potential causes of headache.
CLINICAL PEARLS AND PITFALLS
Classic findings are present in a minority of children with migraine, and
clinical characteristics such as duration and laterality tend to differ from
those in adult patients.
There is limited pediatric evidence to support most commonly used
acute migraine treatments. Nonsteroidal anti-inflammatory agents and
prochlorperazine are the best studied.
While commonly prescribed, opioids are not recommended as first-line
treatment for migraine.
Current Evidence
Migraine—recurrent headaches separated by long, symptom-free intervals—is
probably the most common specific cause of episodic headaches in afebrile
children. In epidemiologic studies, prevalence estimates for migraine in children
range from 3% to 10%. A number of forms of migraine are recognized. Migraine
is considered classic when the headache is well localized and preceded by an aura
and considered common when it is not. The common form of migraine
predominates in children. Cluster headaches, which are unilateral, occur in runs
and are associated with autonomic changes. They represent a rare migraine
variant in childhood. Cyclic vomiting, a syndrome of recurrent, discrete attacks of
abdominal pain, nausea, vomiting, and pallor, is also believed to be a migraine
variant, sometimes called abdominal migraine.
Migraine is a result of an underlying hyperexcitable cerebral cortex. In a
genetically predisposed individual, a variety of stimuli can trigger episodes of
