Hershey Andrew D, Winner Paul K
Division of Neurology, Cincinnati Children's Hospital Medical Center, MLC #2015, 3333 Burnet Ave, Cincinnati, OH 45229-3039, USA.
J Am Osteopath Assoc. 2005 Apr;105(4 Suppl 2):2S-8S.
The diagnosis of migraine headache in childhood rests on criteria similar to those used in migraine in adults. It is important, however, to appreciate several fundamental differences. These differences include the duration of attack, which is often far shorter than in an adult, and the location of the attack, which may be bilateral in many children. The treatment of children and adolescents with migraines includes treatment modalities for acute attacks, preventive medications when the attacks are frequent, and biobehavioral modes of therapy to address long-term management of the disorder. The controlled clinical trials of medications in pediatric migraine have suffered from high placebo response rates that may be related to the sites conducting the study (ie, headache specialist vs clinical research organizations). The medications have proved to be safe in the pediatric age group. Treatment modalities for acute migraine include over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), as well as the oral triptans such as sumatriptan succinate, rizatriptan benzoate, and zolmitriptan and the nasal spray formulations of sumatriptan and zolmitriptan. Subcutaneous sumatriptan and parenteral dihydroergotamine have also been used limitedly. Preventive treatment for patients with frequent or disabling migraines (or both) includes the antidepressants amitriptyline hydrochloride and nortriptyline hydrochloride, the anticonvulsants divalproex sodium and topiramate, and the antihistaminic agent cyprohepatine hydrochloride. Biobehavioral approaches aimed at addressing the fundamental lifestyle issues and nonpharmacologic approaches to management are fundamental to long-term success.
儿童偏头痛的诊断依据与成人偏头痛相似的标准。然而，认识到一些基本差异很重要。这些差异包括发作持续时间，通常比成人短得多，以及发作部位，在许多儿童中可能是双侧的。儿童和青少年偏头痛的治疗包括急性发作的治疗方式、发作频繁时的预防性药物，以及针对该疾病长期管理的生物行为治疗模式。儿科偏头痛药物的对照临床试验存在较高的安慰剂反应率，这可能与开展研究的机构（即头痛专家与临床研究组织）有关。这些药物在儿科年龄组已被证明是安全的。急性偏头痛的治疗方式包括非处方非甾体抗炎药（NSAIDs），以及口服曲坦类药物，如琥珀酸舒马曲坦、苯甲酸利扎曲坦和佐米曲坦，还有舒马曲坦和佐米曲坦的鼻喷雾剂。皮下注射舒马曲坦和胃肠外注射双氢麦角胺也有有限的应用。频繁发作或致残性偏头痛（或两者兼具）患者的预防性治疗包括抗抑郁药盐酸阿米替林和盐酸去甲替林、抗惊厥药丙戊酸和托吡酯，以及抗组胺药盐酸赛庚啶。旨在解决基本生活方式问题的生物行为方法和非药物管理方法是长期成功的基础。
