Paediatric Neurosciences Unit, Royal Hospital for Children, Glasgow, UK.
Expert Rev Neurother. 2022 Apr;22(4):291-299. doi: 10.1080/14737175.2022.2051481. Epub 2022 Mar 15.
Several studies have shown that the response of children with migraine to medications is suboptimum and inferior to the response reported in adults, despite the similar pathogenesis and biological mechanisms. The poor response may be related to the significant differences that make assessment and treatment of children with migraine more challenging than in adults.
The purpose of this review is to discuss the whole process of assessment of children with migraine, the necessary skills for eliciting the clinical features, making the correct diagnosis and exploring lifestyle issues, co-morbid conditions (psychological and physical) and social influences on disease presentations. Also, to establish and address peculiarities of migraine in children that would enable clinicians to advise on lifestyle modifications, co-morbid conditions and the correct choice of treatment options including non-pharmacologic therapies and medications.
The choice of treatment should be based on an assessment of each individual child taking into account, age, gender, pubertal status, body weight, comorbid disorders and family history. Also considering the profile of migraine episodes, frequency, duration, associated symptoms and effects of nausea and vomiting. Using the appropriate medications in appropriate dosage, formulation and route and timing of administration may improve adherence to treatment and outcome.
尽管偏头痛在发病机制和生物学机制上与成年人相似，但已有多项研究表明，儿童对药物的反应不如成年人，不尽如人意。这种不佳的反应可能与一些显著差异有关，这些差异使得评估和治疗儿童偏头痛比治疗成人偏头痛更具挑战性。
本篇综述的目的在于讨论偏头痛患儿评估的整个流程，包括引出临床特征、做出正确诊断、探讨生活方式问题、合并症（心理和生理）以及社会因素对疾病表现的影响等方面所必需的技能。此外，还将探讨儿童偏头痛的特点，使临床医生能够就生活方式改变、合并症以及正确选择治疗方案（包括非药物治疗和药物治疗）提出建议。
治疗的选择应基于对每个个体患儿的评估，考虑年龄、性别、青春期状态、体重、合并症和家族史。还应考虑偏头痛发作的特征、频率、持续时间、伴随症状以及恶心和呕吐的影响。使用适当的药物、适当的剂量、剂型以及给予的时间和途径，可能会提高对治疗的依从性和治疗效果。
