Management of Chronic Migraine in Children and Adolescents: A Brief Discussion on Preventive Therapies
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REVIEW ARTICLE
Management of Chronic Migraine in Children and Adolescents: A Brief Discussion on Preventive Therapies Joanne Kacperski1,2 · Antoinette Green1 · Sharoon Qaiser1
© Springer Nature Switzerland AG 2020
Abstract Pediatric migraine is a debilitating disease that affects about 10% of school-aged children. Like other pain disorders, migraines can be accompanied with sleep, mood, and cognitive difficulties, leading to interruptions in daily tasks required at both school and home. This paper serves as a review of the most current pharmacological treatments available for managing migraine in the pediatric population. Because the management of migraine is complex, we discuss the importance of multidisciplinary care involving pharmacological and non-pharmacological measures, behavioral modifications, and a shared treatment plan between the clinician, patient, and parent/care giver. A diverse group of medications are used to prevent migraine attacks including antiepileptics, antidepressants, antihistamines, and antihypertensive agents, in addition to newer classes of medications; yet there remains a serious lack of controlled studies in the pediatric population. Further clinical research is necessary to have Food and Drug Administration (FDA)-approved medications readily available for migraine sufferers.
1 Introduction Primary headache disorders are recognized as one of the most prevalent health problems worldwide. The 2017 World Health Organization’s systematic analysis on the global burden of disease cited headaches as the second most common cause of years lost due to disability (YLD) and migraine stood alone as the sixth most common cause of YLD [1]. In the United States, it is estimated that migraine has an annual economic impact of $78 billion, with chronic migraine costing $9000 per person annually as compared to non-chronic (episodic) migraine costing $2000 per person annually [2]. Chronic migraine is defined as a headache occurring on 15 or more days/month for at least 3 consecutive months, which, on at least 8 days/month, has the features of migraine headache. Several studies have shown that chronic migraine in pediatric patients affects various areas of functioning including academics, peer interactions, and emotional and family functioning [3]. There is no single theory to explain * Joanne Kacperski [email protected] 1
Division of Neurology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 2015, Cincinnati, OH 45229‑3039, USA
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
2
Key Points Because migraines commonly start in youth, early recognition, establishment of a treatment plan, and implementation of lifestyle changes can alter disease progression and ultimately improve the child’s quality of life. The goals of treatment should ultimately include reducing headache frequency and lessening associated disability. Numerous agents have had limited data in this population and many agents lack efficacy. Although amitri
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