P MIGRAINE

Guidelines Updated on Preventing and Treating Migraine in Children and Teens

By Amy Orciari Herman

Edited by William E. Chavey, MD, MS, and Jaye Elizabeth Hefner, MD

The American Academy of Neurology (AAN) and American Headache Society have issued new guidelines on preventing and treating migraine in children. The guidelines, published in Neurology, update the AAN's 2004 recommendations.

Among the advice for clinicians regarding migraine prevention:

• Counsel patients and their caregivers that lifestyle factors, such as poor sleep habits and tobacco use, can contribute to headache frequency and should be modified.
• Advise patients and their families that most trials of preventive medications have failed to show any benefit over placebo, with potential exceptions: Propranolol may "possibly" result in a 50% reduction in headache frequency in children.

The recommendations on acute treatment include the following:

• Counsel patients and their caregivers that treatment is most effective when given early in the attack. Ibuprofen oral solution (10 mg/kg) should be the initial treatment for children and adolescents. Additionally, adolescents may take triptans, such as sumatriptan/naproxen tablets and zolmitriptan nasal spray.
• For patients who also have substantial nausea and vomiting, offer an antiemetic.
• Caution patients and their families about medication overuse. For example, ibuprofen should not be used more than 14 days a month, and triptans shouldn't be used more than 9 days a month.