Migraine Definition
- Recurrent attacks that last 4-72hours
- Typically one-sided
- Pulsating
- Moderate to severe intensity
- Associated with nausea, photophobia, phonophobia, osmophobia.
- Can occur with or without aura.
- Possible aura symptoms
- Can affect vision, senses, speech, languague, motor function, brainstem, retina.
Pharmacological Management of migraine in children
Analgesia
- Ibuprofen 5-10mg/kg Max 400mg PO Q6H PRN
- 2nd - Paracetamol 15mg/kg Max 1g PO Q4H PRN
Avoid Aspirin due to possibility of Reyes Syndrome.
Triptans - Use if Child >= 6yo and above analgesics ineffective
- Sumatriptan 10-20mg Intranasally. Can repeat after 2 hours max 2x per day.
- Rizatriptan 5-10mg PO. Can repeat after 2 hours.
Note: Avoid use of NSAIDS 15+x or Triptans 8+x per month to avoid medication overuse headaches.
No migraine prophylaxis recommended in childhood unless specialist prescribed. Consider if more than 3-4 severe migraines per month.
Nausea
- Ondansetron 0.1-0.15mg/kg PO PRN
Avoid metoclopramide and prochlorperazine for nausea due to dystonia or sedation.
Non-pharmacological management of migraine
- Keep a symptom diary.
- Regular sleep schedule
- 1.5 - 2L water per day
- Limit caffeine to 1-2 drinks per day
- Regular exercise - 30 mins per day 4x per week
- Good workplace ergonomics with regular short breaks
- Regular use of relaxation techniques (meditation, mindfulness, yoga, breathing techniques) especially if stress was a trigger.
- Avoidance of known triggers (Alcohol, MSG, citrus, chocolate, preserved meat, perfume)
