Treating migraines in children follows the same basic pattern as treatment of adult migraines, though the specifics will vary considerably depending on the child's age, history, and headache specifics. The basic approach for forming a treatment plan for children with migraines includes learning to eliminate triggers, finding medications that work in the short term for acute attacks, and considering preventative medication to help ward off future migraines. Lifestyle changes that encourage stress reduction and relaxation are also important. Children and their parents should keep a headache diary and work with the child's doctors to eliminate other unlikely but possible causes, such as brain tumors or other medical conditions.
Over-the-counter pain relievers such as ibuprofen and acetaminophen are rarely helpful if taken after a migraine has begun. However, these remedies are usually safe for children and can be useful if taken at the very onset of symptoms. Because your child's digestive system will slow down if she has a migraine, liquid forms of medication will be absorbed faster.
Abortive medications, those that work to stop a migraine in its tracks, can be useful for children and fall into the same general classes as adult medications. These include triptans (sumatriptan, zolmitriptan, naratriptan) and ergotamine derivatives (ergotamine, dihydroergotamine). Chapter 7 has more information on these medications.
Some preventative medications, also known as prophylactics, are considered safe for children based on published research and anecdotal use. Prophylactics must be taken over a fairly long period of time in order for them to be effective in reducing migraine severity and frequency. The typical standard of care for using preventative medication is if the child experiences more than two headaches per week that do not respond to other remedies. Preventative medications for children generally fall into one of three categories:
Antiseizure medication(valproic acid)
Antidepressant medication (amitriptyline)
Beta-blockers (propranolol) and
Antidepressant drugs can cause an increased risk of suicidality (suicidal thinking and behavior) in children and adolescents. For this reason, antidepressants may not be the primary drug of choice for migraine prevention in children. If they are prescribed, the child should be closely monitored for signs of self-destructive behavior.
It's important to note that as of the publication of this book, there is no migraine treatment that is FDA approved for use in children, primarily because of the lack of rigorous controlled clinical studies on these drugs in pediatric populations.
Turn to Chapter 8 for more information on migraine prophylaxis.
Steering clear of medications that are known to increase the likelihood of your child suffering a migraine can be a tremendous step in your child's treatment plan. Some of the more common medications on this list include but are not limited to: Cimetdine, nitroglycerin, histamines, Reserpine, Hydralazine, and Ranitidine.
Be aware that childhood headache can be the result of “analgesic rebound.” If your child routinely takes large doses of over-the-counter pain medications, then suddenly stops taking them, chronic headaches can be the unfortunate result. Slow weaning off these medications may help avoid a sudden increase in migraine frequency.
One of the simplest things a child can do to alleviate the pain of a migraine is go back to bed. Sleep removes the light and sound sensitivities that can worsen a migraine and also restores brain function to its normal levels. If your child has difficulty falling asleep, talk to her pediatrician about using a pain reliever to help alleviate the pain long enough so that she can fall asleep. Isolating dietary migraine triggers is an important way to help a child manage migraines. Common culprits, such as dairy, chocolate, and citrus, act in different ways on the body.
Other less well-known triggering foods that children tend to eat include lunchmeat, dry-roasted nuts, most flavored potato chips, bananas, and dried fruit. Keeping a headache diary will help isolate the foods and drinks that may induce migraine in your child.
Potential migraine triggers are covered in greater detail in Chapter 6.
Because young children cannot be given some of the stronger medications that adults take for migraines, take advantage of alternative treatment options. Biofeedback and guided relaxation are two techniques that can work very well in alleviating migraine pain. Health psychologists, headache specialists, or physical therapists can provide assistance with these remedies. Older children and teenagers will typically respond better to these treatments than young children.
Try leading your child on a guided relaxation exercise, one that can help relax the body and improve a migraine. Ask your child to visualize their headache in colors, for example, or numbers. Ask them to imagine the headache fading away as if it were an ice cube placed on a hot sidewalk; visualize the pain melting as the ice melts into a pool of water. Concentrating on any sort of abstract representation will take their focus away from the pain and, in the process, will help alleviate it.