Management of migraine in children and adolescents

Successful management of migraine in childhood and adolescence starts with making the correct diagnosis, assessing the impact of migraine on the child/adolescent's quality of life including impact on education, family life, and social activities. Understanding the child's and family's concerns and reasons for seeking medical advice is an important starting point in the management plan. Pharmacological treatment should go hand-in-hand with appropriate advice on maintaining a healthy life style, avoidance of triggers and aggravating factors, and exploring comorbid disorders that may influence response to treatment. Compared to those available for adult patients, pharmacologic treatment options for migraine in children and adolescents are relatively untested and limited at the present time. Therefore, an individual management plan on the appropriate use of medications, including the limitations of acute treatment and prevention of migraine, should be agreed and well understood by the patient, his/her carers, and school teachers, in order to achieve best results. Treatment of acute migraine episodes should be given as early as possible after onset of headache using an appropriate dose to child's age and weight and in the correct formulation and route of administration. Preventive treatment should be given regularly in a dose titrated to achieve maximum benefit with least adverse effect for at least 6-8 weeks before a judgment is made on its efficacy. Regular monitoring of treatment response can be facilitated by prospective headache diaries and follow-up.