Treatment of acute migraine and status migrainosus in pediatrics

Abstract

Migraine is the most common acute and recurrent headache syndrome in children and adolescents but is often underdiagnosed. Migraine diagnosis in childhood rests on criteria similar to those used in adults but with some particularities, as duration of the attack, which is often much shorter than in adults, and location of the attack, which in many children may be bilateral. Despite its high prevalence, pediatric migraine remains undertreated, sometimes due to fear of caregivers and physicians and lack of studies about its treatment. Although treatment options for pediatric migraine are increasing, they remain limited. In this article, the authors review approved and “off-label” drugs currently used in migraine and status migrainosus acute treatment in pediatric patients. In migraine treatment, nonsteroidal anti-inflammatory drugs (NSAIDs) should be used. In moderate-to-severe migraine unresponsive to analgesics or NSAIDs, triptans may be used, alone or in combination with the former. Rescue medication, including dihydroergotamine and sodium valproate, can be used in hospital setting for intractable migraine. Antiemetics with anti-dopaminergic properties may be helpful in patients with symptoms of nausea and vomiting in addition to headache, particularly when used in combination therapy.