Asuncion Ria Monica D., Al Khalili Yasir, Chopra Pooja
University of Santo Tomas, Medicine and Surgery
Virginia Commonwealth University
Migraine and headache disorders are among the leading causes of disability and morbidity worldwide. Migraine is the most frequent primary headache disorder in children and adolescents. About 1 in 10 children experience recurrent headaches due to migraine, which can significantly impair school performance and quality of life. Up to 18% of patients in the pediatric emergency room are found to be migraine-related. However, migraines in children differ from those in adults because they are often associated with other symptoms, not only headaches. Migraine in children also manifests conditions like cyclic vomiting and abdominal migraine, wherein children are usually considered to have gastrointestinal tract disorder. The diagnosis of migraine in children and adolescents remains a clinical diagnosis. The clinician must obtain a detailed and comprehensive headache history that focuses on the pain's location, quality, severity, and duration. Nonetheless, complicated migraine is often associated with focal neurological symptoms such as ataxia, hemiparesis, or altered level of consciousness that concerns the examining clinician. Some episodic syndromes may show ambiguity, such as migraine triggered by trauma. Acute treatment recommendations for children include using over-the-counter analgesics and triptan medications approved by the US Food and Drug Administration. Preventive treatment strategies involve lifestyle modifications, behavioral approaches, and consideration of preventive medications with the lowest side effect profiles. There are evidence-based recommendations for the acute symptomatic treatment of migraine in children, which support the efficacy of using ibuprofen, acetaminophen, and triptans. However, no acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia. Recommendations focus on the significance of early treatment, selecting the most suitable route of administration in relation to the characteristics of the migraine attack, and offering counseling assistance regarding lifestyle modification to prevent exacerbation of migraines, such as trigger avoidance and medication overuse.
偏头痛和头痛性疾病是全球致残和发病的主要原因之一。偏头痛是儿童和青少年中最常见的原发性头痛疾病。每10名儿童中约有1人因偏头痛而反复头痛，这会严重影响学业成绩和生活质量。在儿科急诊室中，高达18%的患者被发现与偏头痛有关。然而，儿童偏头痛与成人偏头痛不同，因为它们通常与其他症状有关，而不仅仅是头痛。儿童偏头痛还表现为周期性呕吐和腹型偏头痛等情况，在这些情况下，儿童通常被认为患有胃肠道疾病。儿童和青少年偏头痛的诊断仍然是临床诊断。临床医生必须获取详细而全面的头痛病史，重点关注疼痛的部位、性质、严重程度和持续时间。尽管如此，复杂性偏头痛通常与共济失调、偏瘫或意识水平改变等局灶性神经症状有关，这让检查的临床医生感到担忧。一些发作性综合征可能存在模糊性，例如由创伤引发的偏头痛。儿童急性治疗建议包括使用非处方镇痛药和美国食品药品监督管理局批准的曲坦类药物。预防性治疗策略包括生活方式改变、行为方法以及考虑使用副作用最小的预防性药物。有基于证据的儿童偏头痛急性症状治疗建议，支持使用布洛芬、对乙酰氨基酚和曲坦类药物的疗效。然而，没有急性治疗方法对与偏头痛相关的恶心或呕吐有效；一些曲坦类药物对与偏头痛相关的恐声症和畏光症有效。建议重点关注早期治疗的重要性，根据偏头痛发作的特点选择最合适的给药途径，并提供关于生活方式改变的咨询帮助，以防止偏头痛加重，如避免触发因素和药物滥用。
