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Migraine Headache Management in Children

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  1. See Also
    1. Headaches in Children
    2. Migraine Headache
    3. Migraine Headache Management
    4. Migraine Management Clinic Schedule
    5. Migraine Abortive Management
    6. Migraine Prophylaxis
    7. Migraine Headache Care in the Emergency Department
  2. General
    1. See Headache General Measures
    2. Keep medication available at all times (school)
    3. Use adequate dosages
    4. Decrease provocative factors
      1. Decrease caffeine intake (very important)
      2. Decrease Migraine Headache Triggers
      3. Decrease Tyramine-Vasoactive Amines
  3. First-Line Medications
    1. Acetaminophen (Tylenol) 15 mg/kg q6 hours
    2. Ibuprofen (Motrin) 10 mg/kg q6 hours
    3. Naproxen sodium (Anaprox) 5 mg/kg bid
  4. Second-Line Medications
    1. Isometheptene (Midrin)
  5. Third-Line Medications (off label use)
    1. Appear to be safe and effective for age 6 and over
    2. Triptans (Adjust dose for weight)
      1. Sumatriptan (Imitrex)
        1. Imitrex nasal spray 10 mg (weight 44-85 pounds)
        2. Imitrex nasal spray 20 mg (weight >85 pounds)
      2. Zolmitriptan (Zomig)
      3. Rizatriptan (Maxalt)
  6. Anti-emetics
    1. Promethazine (Phenergan) 0.25 to 0.5 mg/kg/dose tid
    2. Metoclopramide (Reglan) 1-2 mg/kg up to 10 mg q4 hours
  7. Prophylaxis (for frequent or disabling Headache)
    1. See Migraine Prophylaxis
    2. Age over 12 years old
      1. See Migraine Prophylaxis
    3. Age under 10 to 12 years old
      1. First Line
        1. Propranolol (Inderal)
          1. Only agent proven effective in children
          2. Wasiewski (2001) J Child Neurol 16:71
      2. Second Line
        1. Amitriptyline (Elavil)
        2. Cyproheptadine (Periactin) 2 to 8 mg PO qhs
        3. Propranolol (Inderal)
        4. Carbamazepine (Tegretol)
        5. Valproic Acid (Depakene)
        6. Topamax (Topiramate)
        7. Keppra (Levetiracetam)
  8. References
    1. Lewis (2002) Am Fam Physician 65(4):625
    2. Winner (1997) Postgrad Med 101(5):81

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