Division of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
Pediatric Headache Program, Division of Neurology, Children's Hospital of Philadelphia (CHOP), 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Curr Neurol Neurosci Rep. 2021 Jun 4;21(8):38. doi: 10.1007/s11910-021-01128-9.
Intractable migraine in children and adolescents is a significant cause of disability and decreased quality of life (QoL) in this population. Challenges include lack of unifying definition for intractable migraine, and limited data on best-practice management in this age group, with most current treatment pathways extrapolated from adult studies or expert consensus.
A comprehensive approach in the evaluation and management of intractable migraine in this age group encompasses excluding secondary causes of headache; making an accurate diagnosis; identifying and appropriately managing modifiable risk factors; and initiating appropriate pharmacologic therapy to reduce disability, improve health-related quality of life, reduce risk of progression, and develop adaptive pain coping strategies. Several strategies for management of pediatric intractable migraine including use of acute medications, bridge therapy in outpatient setting, emerging therapies for preventive therapy, and a stepwise combination therapy for management of pediatric intractable migraine in emergency and inpatient setting are presented based on available clinical data, safety/tolerability, availability, cost-effectiveness, and expert consensus. This descriptive review of the available literature focuses on approach to therapy for acute intractable migraine in a pediatric population including outpatient, emergency department (ED), and inpatient management.
目的：儿童和青少年的难治性偏头痛是该人群残疾和生活质量（QoL）下降的一个重要原因。挑战包括缺乏难治性偏头痛的统一定义，以及该年龄段最佳治疗管理的数据有限，大多数当前的治疗途径都是从成人研究或专家共识中推断出来的。
发现：该年龄段难治性偏头痛的全面评估和管理方法包括排除头痛的继发性原因；做出准确的诊断；识别和适当管理可改变的危险因素；并启动适当的药物治疗，以减少残疾，改善与健康相关的生活质量，降低进展风险，并制定适应性疼痛应对策略。根据现有临床数据、安全性/耐受性、可用性、成本效益和专家共识，提出了几种治疗儿童难治性偏头痛的策略，包括急性药物的使用、门诊桥接治疗、预防治疗的新疗法，以及急诊和住院环境中儿童难治性偏头痛的阶梯式联合治疗。对现有文献的描述性回顾重点介绍了治疗儿科人群急性难治性偏头痛的方法，包括门诊、急诊科（ED）和住院管理。
