Even in children, a complete anamnesis and a general and neurological examination are the most important elements for establishing a diagnosis. The diagnostic criteria for headache were also adapted according to the age of the child in the second International Classification of Headache. The majority of children suffer from either migraines, tension headaches, or hybrid forms of both. The migraine with aura rarely occurs at school age, it develops rather during adolescence, a strong family predisposition being again a more dominant factor than for a simple migraine.
Imaging methods are only indicated if the history is unusual for primary headaches and has indicators of “dangerous” headache and / or if the neurological examination has abnormalities. Correct information can ward off parents’ fear that a brain tumor is found in primary headaches. It is important to keep a headache diary, with menstrual cycle calendar for teenage girls, to enable reliable diagnosis and monitoring of treatment. A good lifestyle to avoid headaches is essential and it is precisely during childhood that it is particularly useful: regular meals (punctual also before a sports activity), a sufficient volume of drink, avoid consumption regular caffeinated beverages (Coca-Cola, Red Bull, iced tea) and adequate sleep time. It must also be ensured that there is no overload situation due to school overwork or a plethora of leisure activities.
Treatment should take into account the different forms of headache and differences in the course of migraine attacks in children.
1. Acute treatment of migraine
In pre-school and early-school children, a small “sleep cure” often helps to calm a brief migraine attack without the need for medication. In older children and adolescents, in addition to an attitude of care and avoidance of triggers, emergency medication is often necessary in case of long-term seizures (> 1 / 2h or 1h) and / or serious, and as early as possible during the crisis.
Analgesics / NSAIDs:
1. Paracetamol (including suppositories, orodispersible tablets) 15 mg / kg MC / max. every 5 to 6h
2. Ibuprofen (tablets and syrup) 5 to 10 mg / kg MC / max. every 6h
3. Mefenamic acid 5 (at 10) mg / kg MC / max dose every 8h
4. Acetylsalicylic acid (only from 12 years old!) 10 mg / kg MC / max dose every 6 to 8h
In children over the age of 12 whose response to these analgesics is insufficient, the only triptan formulation authorized in Switzerland is sumatriptan 10 or 20 mg nasal spray.
Sumatriptan (only from 12 years old!) Nasal Spray (SN) 10 mg for a MC <40 kg
SN 20 mg for body mass (MC)> 40 kg
(max 40 mg / 24h)
Antiemetics: (administered in case of nausea due to emergency medication)
Domperidone Suspension 0.25 mg / kg MC / max dose every 6h
Suppositories 1 mg / kg MC / maximum dose every 6h
Orodispersible tablets 10 mg> 35 kg MC
max. every 12h
2. Long-term migraine prophylaxis
Rarely indicated: if the crisis treatment is ineffective and / or if the seizures are frequent (3 to 4 moderate to severe attacks with absence from school / leisure activities / month), several times during adolescence.
The most effective in children and adolescents according to reported observations:
Flunarizine 1 to 2 cpr. at 5 mg / day Cave: depressed mood possible,
Weight gain and sleepiness
frequent (taken in the evening!).
In overweight patients due to side effect profile (decreased appetite):
Topiramate 50-max. 100 mg / day Cellar: at higher dosage
Neurocognitive side effects!
Other possibilities (less data reported but frequently used in first intention because better tolerance profile):
Magnesium 9mg / kg MC / day = 0.37 mmol / kg MC / day in 2 to 3 single doses (DU)
Riboflavin 200 to 300 (max 400) mg / day in 2 DU
In the case of frequent use of emergency medicines (> 10 days of treatment / month in more than 3 months), it has been observed, rarely in children and infrequently in adolescents, headaches induced by overuse of drugs .
3. Teenage migraineIt should be considered the possibility of migraine menst alley. Hormonal therapy may be prescribed at the discretion of a headache specialist or a specialized endocrinologist gynecologist.
4. Tension headaches
For many children, the main causes of “tension” (most often difficult family or school situations) need to be addressed to avoid headaches, which can be difficult. Therefore, stress reduction measures are essential: a regular rhythm of life with adequate sleep and outdoor physical activity is often sufficient to improve conditions in school-aged children. The painkillers used in case of a migraine attack should be used sparingly and only in case of pain of at least moderate intensity. Relaxation methods, such as Autogenic training, Jacobson-based therapeutic relaxation, biofeedback methods, behavioral therapy, and complementary medicine methods may have a beneficial effect on headaches, although most of these methods still lack evidence. concerning their effectiveness in children. Magnesium also can be used in dosages equivalent to those for migraine, although there are still few studies done on this subject.
5. Chronic and chronic headaches daily
These types of headaches, the cause of which is often imprecisely defined and occurring particularly in adolescents, are generally difficult to combat with treatment and require experience with specialist headache management.