Materiały źródłowe

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics/print

  Headaches are a common complaint in children and adolescents, occurring in up to 75 percent of school-aged children. […] This topic reviews the causes, evaluation, and treatment of headaches in children and adolescents. […] The treatment of headaches depends upon the child’s age, the type and frequency of headaches, and other factors. […] A child who has a headache caused by an underlying illness or minor head injury should have the underlying illness treated. The headache can be treated similarly to that in a child with a tension-type headache (TTH). […] Infrequent tension-type headache (TTH) is defined as occurring less than once per month. Children with infrequent tension-type headaches may be treated with an over-the-counter (OTC) pain medication, such as children’s acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin).

• #1 Treatment of Pediatric Migraine: a Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5394581/

  Migraine treatment is divided into two broad areas: acute and preventive therapies. […] The education of the family and child regarding migraine headache is an important issue. Children who experience migraine, as well as their families, may benefit from creating a migraine journal where they can mark each episode, describing the attack in order to find a pattern and to identify the potential triggering factors and the response they have after administrating different therapies. […] When a migraine episode starts the child should rest or sleep in a dark and quite room, with a cool cloth applied on his forehead. Medications for the acute treatment should be given early in the course of the migraine. […] The goals of acute treatment are to treat each attack as it occurs and allow the return to normal activities. This type of treatment is needed by all patients.

• #1 Headaches in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/diagnosis-treatment/drc-20352104

  Usually you can treat your child’s headache at home with rest, decreased noise, plenty of fluids, balanced meals and over-the-counter (OTC) pain relievers. If your child is older and has frequent headaches, learning to relax and manage stress through different forms of therapy may help, as well. […] OTC pain relievers. Acetaminophen or ibuprofen (Advil, Motrin IB, others) can typically relieve headaches for your child. They should be taken at the first sign of a headache. […] Prescription medications. Triptans, prescription drugs used to treat migraines, are effective and can be used safely in children older than 6 years of age. […] While stress doesn’t appear to cause headaches, it can act as a trigger for headaches or make a headache worse. Depression also can play a role. For these situations, your doctor may recommend one or more behavior therapies, such as:

• #1 Treatment of Pediatric Migraine: a Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5394581/

  Patients who experience nausea associated or not with vomiting benefit from the placement of an intravenous line in order to receive antiemetic treatment. […] Acetaminophen and ibuprofen are the most commonly used over-the-counter treatments for pain relief and antipyretics in children. For acute migraine treatment, acetaminophen is used in doses of 15 mg/kg, and ibuprofen in doses of 7.5 10 mg/kg. […] Triptans are a class of tryptamine-based pharmacological agents which act as serotonin agonists, helping reduce cerebral blood flow and neuropeptide release. […] For children who, despite submitting to nonpharmacological treatments, still experience frequent migraine attacks, often disabling and a major cause of school absence and lower quality of life, prophylactic treatment is required.

• #1

  https://myhealth.alberta.ca/alberta/Pages/headache-treatments-for-children.aspx

  There are 3 types of medicines to treat headaches in children, called rescue medicines. Rescue medicines dont stop your child from getting headaches, but they can make your child feel better. These medicines include: […] Pain relievers work well for migraine attacks and tension-type headaches. Your child needs to take them as soon as a headache starts (within the first hour). […] Dont give your child pain relievers more than 2 or 3 times a week. Pain relievers can cause more headaches if you take them regularly for weeks or months. […] Talk to your childs healthcare provider if you have questions about pain relievers for headaches. […] Anti-nausea medicines help stop nausea and vomiting from happening. They can also help pain relievers work better. […] Antimigraine medicines (triptans or gepants) are prescription medicines that are sometimes used for migraine attacks when pain relievers dont work.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  HEADACHE TREATMENT […] The treatment of headaches depends upon the child’s age, the type and frequency of headaches, and other factors. […] Illness- or injury-related headache treatment — A child who has a headache caused by an underlying illness or minor head injury should have the underlying illness treated. The headache can be treated similarly to that in a child with a tension-type headache (TTH). […] Tension-type headache treatment […] Infrequent TTH — Infrequent tension-type headache (TTH) is defined as occurring less than once per month. Children with infrequent tension-type headaches may be treated with an over-the-counter (OTC) pain medication, such as children’s acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). Aspirin is not recommended in children who are less than 16 years old due to the risk of a rare but serious condition called Reye syndrome. The dose of acetaminophen (10 to 15 mg/kg per dose) and ibuprofen (7.5 to 10 mg/kg per dose) should be based upon the child’s weight, rather than age.

• #1 Migraines in Children: Recommendations for Acute and Preventive Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p569.html

  No medications have been shown to be more effective than placebo for preventing migraine in children and adolescents. […] CBT appears to be effective for reducing migraine frequency in children and adolescents. […] First-line acute migraine treatment in children is ibuprofen; adolescents may benefit from sumatriptan/naproxen tablets, zolmitriptan nasal spray, sumatriptan nasal spray, rizatriptan, or almotriptan. […] Overuse of acute medication to treat migraines increases headache frequency. […] Counseling and education are important for patients and their families, especially because of the lack of useful pharmacologic therapy. […] Preventive pharmacologic medications were not superior to placebo in most randomized controlled trials, yet the placebo response is high. […] Although amitriptyline combined with CBT has been shown to be more effective than amitriptyline without CBT, amitriptyline has a boxed warning from the U.S. Food and Drug Administration concerning risk of suicidal thoughts and behavior in children and adolescents.

• #1 Pediatric Headache Treatment & Management: Approach Considerations, Treatment of Migraine and Tension-Type Headaches, Treatment of Chronic Daily Headache

  https://emedicine.medscape.com/article/2110861-treatment

  Some authors believe that early diagnosis and prompt initiation of optimal treatments (abortive and preventive) lead to better treatment outcome and prognosis and less disability for children and adolescents with migraine. […] Treatment of a secondary headache is focused on its specific cause, but an additional, symptomatic therapy may be useful as long as the cause has not yet been eradicated. As for a primary headache, always consider a preventative treatment and a symptomatic therapy. […] The short-term goals of therapy for migraine and tension-type headache are to relieve pain, alleviate nausea, and promote sleep. The long-term goals are to improve the patients quality of life by reducing the frequency and severity of headache episodes. The treatment of chronic daily headache (CDH) combines therapies that are used for tension-type and migraine headache.

• #1 Headache Treatment

  https://www.nationwidechildrens.org/specialties/headache-clinic/headache-treatment

  Over the Counter medicines (OTCs) include: ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and naproxen (Naprosyn, Aleve). These are usually the first pain medicines to try for headaches. […] Prescription NSAIDs (non-steroidal anti-inflammatory drug) include: diclofenac, ketorolac, and indomethacin. If over-the-counter pain medicines do not stop headaches, your provider may prescribe a prescription NSAID to try for pain relief. […] Triptans are a group of medicines used just for the treatment of migraine headaches. Triptans can lessen inflammation and narrow blood vessels in the brain to slow down the spread of migraine symptoms. […] If one Triptan does not work, the provider may recommend trying a different one. Triptans work the best if taken at the start of migraine symptoms. […] Corticosteroids (like prednisone) may be used for treatment of severe migraine headaches or for longer migraines (that last at least 72 hours).

• #1 Pediatric Headache Treatment & Management: Approach Considerations, Treatment of Migraine and Tension-Type Headaches, Treatment of Chronic Daily Headache

  https://emedicine.medscape.com/article/2110861-treatment

  Stress, as a trigger and as a consequence of headache, is a logical target for nonpharmacologic therapy. […] Patients who are prone to tension headaches should attempt to minimize stress and may benefit from behavioral/relaxation therapy. […] Consider prophylactic therapy when headaches are frequent enough to interfere with the patient’s lifestyle. […] In general, the effect of prophylactic therapy is not immediate, often taking as long as 6-8 weeks before improvement occurs. […] Migraines are known to remit spontaneously in some patients during childhood. […] Beta-blockers are commonly used as prophylactic therapy for childhood migraine; propranolol and nadolol are each effective. […] Tricyclic agents (amitriptyline, nortriptyline) are frequently used for prophylactic therapy, especially in older children and adolescents.

• #1 Frontiers | Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade?

  https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00771/full

  Here, our aim is to investigate the actual evidence concerning prophylactic therapy of pediatric migraine by reviewing clinical studies published between 2010 and 2019. […] Flunarizine is a calcium channel blocker with properties on the cerebrovascular circulation. […] Propranolol is a non-selective beta (b) adrenoceptor antagonist that blocks the b1,2 receptors. […] Amitriptyline is one of the most used drugs for preventive treatment of pediatric migraine. […] Sodium Valproate (500–1,500 mg/day) and topiramate (50–100 mg/day) were evaluated for prophylactic therapy of pediatric migraine in some controlled studies. […] Pizotifen was studied in a placebo controlled trial conducted on 37 subjects (6–15 years), at a dosage of 1.5 mg/day, with a significant reduction in attack frequency and mild side effects.

• #1 Treatment of Pediatric Migraine: a Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5394581/

  Amitriptyline is the most used and efficacious tricyclic antidepressant in children. […] Newer antiepileptic drugs such as topiramate, gabapentin and levetiracetam have been shown to reduce headache frequency in open-label, retrospective trials. […] An important part of the prophylactic treatment in pediatric migraine is the psychological support that should be given to each child in order to have a compliant patient without any further emotional disorders that may arise from both the pressure of the daily treatment as well as the vulnerability and emotional fragility that characterize these particular age categories.

• #1 Headache | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/general-medical-conditions/headache/

  Preventive medications fall broadly in to four major categories of medications antihistamines, anticonvulsants, beta blockers and calcium and dopaminergic antagonist. […] Medication commonly used include pizotifen, propranalol, topiramate, amitriptyline and sodium valproate. […] Flunarizine is believed to be the most effective form of prevention for migraines. […] Psychological ways of managing headaches can be very helpful. Sessions can either be on a one-to-one basis with a psychologist or in a group. […] Learning ways of coping with headache pain can be helpful, such as relaxation, stress management and guided imagery.

• #1 Migraines in Children: Recommendations for Acute and Preventive Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p569.html

  Medication effectiveness and adverse events should be monitored regularly because of the limited evidence for preventive treatment and unclear guidance about when treatment should be stopped. […] The American Academy of Neurology and American Headache Society conducted a systematic review of the effectiveness of pharmacologic treatment for acute migraine in children and adolescents. […] There is strong evidence that sumatriptan/naproxen (Treximet) combination oral tablets and zolmitriptan (Zomig) nasal spray relieve pain at two hours more often than placebo. […] Triptans are prescribed less often in children; therefore, ibuprofen is recommended for initial treatment.

• #1 Headache Treatment

  https://www.nationwidechildrens.org/specialties/headache-clinic/headache-treatment

  Daily medicine may be used if a patient often has headaches that interfere with work, school or social activities. […] At this time there are no daily headache preventive medicines for children that are FDA approved. […] Non-prescription medicines and supplements for headache or migraine prevention include: Magnesium, Riboflavin (Vitamin B2), Coenzyme Q10, Feverfew, Petasites (Butterbur root). […] This is in the drug category of tricyclic antidepressants. […] Clinical studies in adults show that it helps to treat headaches. This has been used successfully in adolescents and younger children when used for frequent migraine or tension headaches. […] This is a seizure prevention medicine which is also approved by the FDA for headache prevention in adults. It is used commonly in children with headaches.

• #1 Behavioral management of headache in children and adolescents | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-016-0671-4

  The goal of this review is to examine the existing literature on behavioral therapies used to treat headache in children and adolescents, and so provide an up-to-date picture of what behavioral therapy is and what its effectiveness is. […] Moreover, medications should generally not be prescribed alone but rather in combination with non-pharmacological therapies. […] In addition, behavioral therapy help maximize long-term therapeutic benefit and ensure compliance with pharmacological treatment, which has been proven a significant problem with headache patients. […] The goals of behavioral treatments are to reduce the frequency and severity of pain, increase the patients control of their headaches, reduce related disabilities and symptoms, and limit reliance on poorly tolerated or unwanted medications.

• #1

• #1 Headaches in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/diagnosis-treatment/drc-20352104

  Relaxation training. Relaxation techniques include deep breathing, yoga, meditation and progressive muscle relaxation, in which you tense one muscle at a time. Then you completely release the tension, until every muscle in the body is relaxed. An older child can learn relaxation techniques in classes or at home using books or videos. […] Biofeedback training. Biofeedback teaches your child to control certain body responses that help reduce pain. During a biofeedback session, your child is connected to devices that monitor and give feedback on body functions, such as muscle tension, heart rate and blood pressure. […] Cognitive behavioral therapy. This therapy can help your child learn to manage stress and reduce the frequency and severity of headaches. During this type of talk therapy, a counselor helps your child learn ways to view and cope with life events more positively.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics/print

  Many children with chronic headaches overuse acute medications, and this overuse may play a major role in causing their chronic headaches. Therefore, it is important to discontinue any overused pain medications (eg, acetaminophen [sample brand name: Tylenol], ibuprofen [sample brand names: Advil, Motrin]) or prescription medications (such as the triptan class of medication) as quickly as possible. […] One of the more effective treatments for chronic migraine is CBT combined with amitriptyline. Most children can benefit from this within four to six weeks and will have a sustained positive result.

• #1

  https://www.healthychildren.org/English/health-issues/conditions/treatments/Pages/Natural-Therapies-for-Children-with-Chronic-Headaches.aspx

  Massage therapy may be helpful for a child with chronic daily headaches and includes a variety of techniques in which practitioners manipulate the soft tissues of the body. […] Acupuncture may also benefit a child with headaches. […] Biofeedback is one of the treatments researched most extensively for migraines. […] Guided imagery, self-hypnosis, or relaxation can be helpful for preventing headaches. […] All dietary supplements should be discussed with the child’s pediatrician before use. […] Riboflavin is a B-vitamin that may reduce the number of headaches and pain. […] Magnesium supplements may also help reduce the number of headaches if taken for several months. […] Coenzyme Q10 (CoQ10) is an antioxidant present in each cell of our bodies; however, it was found to be deficient in one third of children with migraines. […] Butterbur is an herb extract that may reduce the number and severity of migraine headaches. […] If you’ve made the decision to seek a natural therapy for your child’s headaches, it is of utmost importance to involve your child’s pediatrician in the process.

• #1 Headaches in children | Hull University Teaching Hospitals NHS Trust

  https://www.hey.nhs.uk/patient-leaflet/headaches-in-children/

  If your child starts to experience frequent headaches it is helpful to keep a headache diary so that when you see your doctor, they may be able to identify potential triggers. […] Some headaches can be serious so if you are concerned, speak to your doctor. […] Your child should be assessed by their doctor if: The headaches are getting worse, They are having a headache more than once a week, The headache wakes your child from sleep, Your child wakes with a headache or it is worse first thing in the morning, The headaches begin to disrupt your child’s school, home or social life, You identify that stress is causing your child’s headaches but cannot manage it without further help. […] You should attend the Emergency Department or call 999 if: Your child is having seizures, Your child becomes very drowsy or difficult to wake up, Your child becomes floppy, The headache is associated with vomiting, high fevers, neck stiffness or rashes.

• #1 Chronic Headaches in Children | Duke Health

  https://www.dukehealth.org/treatments/pediatric-neurology/chronic-headaches-children

  Botulinum toxin A (Botox) treatments may be recommended for children age 12 and older who have chronic migraine headaches that have not responded to other treatments. […] Vitamins and supplements may play a role in reducing the severity and frequency of headaches. Biofeedback, acupuncture, yoga, physical therapy, and mindfulness training may also be recommended. […] We help create a Migraine Action Plan to ensure that your child receives prompt treatment at school at the earliest signs of a migraine. The plan helps office staff and school nurses determine quickly if your child needs prescribed medicine, so a headache doesnt progress and cause your child unnecessary pain or significant missed class time. […] Our pediatric neurologists, headache pediatric nurse practitioner/pediatric mental health specialist, and social worker are able to help most children who follow a care plan to reduce headache frequency and severity.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  One of the more effective treatments for chronic migraine is CBT combined with amitriptyline. Most children can benefit from this within four to six weeks and will have a sustained positive result. […] Some children with chronic headaches stop attending school or other normal daily activities. It is important to encourage the child to return to these activities as a part of treatment. If necessary, the child can be allowed to lie down in the school nurse’s office for a brief period (eg, 15 minutes once daily) when headache pain is worst.

• #1 Pediatric Headache Treatment & Management: Approach Considerations, Treatment of Migraine and Tension-Type Headaches, Treatment of Chronic Daily Headache

  https://emedicine.medscape.com/article/2110861-treatment

  Drugs used in symptomatic treatment should be chosen carefully according to headache type (eg, beta-blockers or cyproheptadine for migraine, amitriptyline for migraine or tension-type headache), frequency (eg, amitriptyline for more frequent/chronic headache), type of symptoms (cyproheptadine if prominent vomiting), adverse-effect profile (eg, no beta-blockers if asthma). […] The current opinion is that rather than using a step-care treatment starting with the least expensive drugs and then stepping up as needed, the stratified care approach is best; up front the patient situation is assessed and the severity and level of care needed is taken into account to decide on the most effective and overall cost-containing treatment. […] Adjusting treatment is recommended until the most efficient regimen is found; this regimen would treat all symptoms, including the headache itself but also other complaints such as nausea, vomiting, and photophobia.

• #2 Headaches in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/symptoms-causes/syc-20352099

  Headaches in children usually can be treated with over-the-counter (OTC) pain medications and healthy habits such as a regular schedule for sleeping and eating. […] Your doctor may recommend preventive medication if the headaches are severe, occur daily and interfere with your child’s normal lifestyle. Certain medications taken at regular intervals such as certain antidepressants, anti-seizure medications or beta blockers may reduce the frequency and severity of headaches.

• #2 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics/print

  If a child has frequent or chronic TTH (ie, ≥15 headache days per month), the first line of treatment is an OTC rescue pain medication, such as children’s acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). […] The first medication generally recommended to stop an attack of migraine is an OTC rescue pain medication, such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). […] There are two types of migraine treatments: acute and preventive. Acute treatments are administered to treat the current migraine attack symptoms (eg, pain, nausea, etc), while preventive treatments are given to prevent attacks of migraine from developing. […] Chronic headaches occur ≥15 days per month. The treatment of chronic migraine or chronic tension-type headaches is usually multimodal and includes preventive treatment, healthy lifestyle adjustment, and CBT.

• #2 Migraines in Children: Recommendations for Acute and Preventive Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p569.html

  No medications have been shown to be more effective than placebo for preventing migraine in children and adolescents. […] CBT appears to be effective for reducing migraine frequency in children and adolescents. […] First-line acute migraine treatment in children is ibuprofen; adolescents may benefit from sumatriptan/naproxen tablets, zolmitriptan nasal spray, sumatriptan nasal spray, rizatriptan, or almotriptan. […] Overuse of acute medication to treat migraines increases headache frequency. […] Counseling and education are important for patients and their families, especially because of the lack of useful pharmacologic therapy. […] Preventive pharmacologic medications were not superior to placebo in most randomized controlled trials, yet the placebo response is high. […] Although amitriptyline combined with CBT has been shown to be more effective than amitriptyline without CBT, amitriptyline has a boxed warning from the U.S. Food and Drug Administration concerning risk of suicidal thoughts and behavior in children and adolescents.

• #2 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  There are two types of migraine treatments: acute and preventive. Acute treatments are administered to treat the current migraine attack symptoms (eg, pain, nausea, etc), while preventive treatments are given to prevent attacks of migraine from developing. […] Acute treatments — The first medication generally recommended to stop an attack of migraine is an OTC rescue pain medication, such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). This should be given as soon as possible, at the first sign of the attack. Studies have suggested that ibuprofen is superior to acetaminophen in stopping an acute migraine attack. […] Preventive treatments — Evidence regarding the safety and efficacy of preventive treatments for migraine is limited. Several medications have been tested in clinical trials, but none have shown consistent benefit over placebo (a sugar pill). Nevertheless, some experts have found the following medications to be helpful: […]

• #2

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2288

  Don’t let your child take medicine for headache pain too often. Talk to your child’s doctor if your child is taking medicine more than 2 days a week to stop a headache. Taking too much pain medicine can lead to more headaches. These are called medicine-overuse headaches. […] To prevent migraine headaches in your child, try these tips. […] Seek help if you think your child may be depressed or anxious. Treating these problems may reduce the number of migraines your child has.

• #2 Treatment of Migraine in Children | AMF

  https://americanmigrainefoundation.org/resource-library/treating-migraine-in-children/

  Pediatric migraine is unique, and it requires an individualized treatment plan with the aid of specialists who understand and have expertise in the diagnosis and treatment of migraine. […] The approach to migraine treatment depends on the level of disability a child or adolescent experiences. […] If the migraine attacks cause a moderate-to-severe disability—pain that lasts for two to six hours—and prevents the child from staying in school or participating in his or her usual activities, your provider should recommend an abortive (also referred to as acute or rescue) medication. […] Two of the most effective classes of medications available for acute migraine treatment are: Non-steroidal anti-inflammatory medications (NSAIDs) and Triptans/ergots. […] It’s important to remember that children and adolescents should limit acute pain treatment to two days a week.

• #2 Migraines in Children: Recommendations for Acute and Preventive Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0501/p569.html

  Medication effectiveness and adverse events should be monitored regularly because of the limited evidence for preventive treatment and unclear guidance about when treatment should be stopped. […] The American Academy of Neurology and American Headache Society conducted a systematic review of the effectiveness of pharmacologic treatment for acute migraine in children and adolescents. […] There is strong evidence that sumatriptan/naproxen (Treximet) combination oral tablets and zolmitriptan (Zomig) nasal spray relieve pain at two hours more often than placebo. […] Triptans are prescribed less often in children; therefore, ibuprofen is recommended for initial treatment.

• #2

  https://myhealth.alberta.ca/alberta/Pages/headache-treatments-for-children.aspx

  There are 3 types of medicines to treat headaches in children, called rescue medicines. Rescue medicines dont stop your child from getting headaches, but they can make your child feel better. These medicines include: […] Pain relievers work well for migraine attacks and tension-type headaches. Your child needs to take them as soon as a headache starts (within the first hour). […] Dont give your child pain relievers more than 2 or 3 times a week. Pain relievers can cause more headaches if you take them regularly for weeks or months. […] Talk to your childs healthcare provider if you have questions about pain relievers for headaches. […] Anti-nausea medicines help stop nausea and vomiting from happening. They can also help pain relievers work better. […] Antimigraine medicines (triptans or gepants) are prescription medicines that are sometimes used for migraine attacks when pain relievers dont work.

• #2 The optimal management of headaches in children and adolescents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4710107/

  The most recent practice parameter guidelines for treatment of pediatric headaches recommend either analgesics and/or triptans as first-line treatment for acute migraine. […] It is important for patients to be educated on the correct use of triptans to avoid potential overuse and unwanted adverse effects. […] Management of pediatric migraine requires a tailored regimen of pharmacological and behavioral measures that consider the child’s headache burden and their level of disability. […] Prevention should be limited to those patients whose headaches occur with sufficient frequency or severity to warrant daily medication. […] The evaluation of a child with headaches should always incorporate headache disability and quality-of-life assessments, and a sense of functional disability should also be established before committing the child to a course of daily medication.

• #2 Evidence Based Strategies: Pediatric Headaches Giving You a Headache? | Children’s Mercy Kansas City

  https://www.childrensmercy.org/health-care-providers/refer-or-manage-a-patient/connect-with-childrens-mercy/newsletter-the-link/2024/the-link—2024/evidence-based-strategies-pediatric-headaches-giving-you-a-headache/

  Although headache in the pediatric population is a common complaint in the primary care setting, little education on management is given to providers. […] Treatment should address both the acute symptoms and prevention. Acute treatment includes common analgesics such as ibuprofen, acetaminophen, naproxen, and ASA/acetaminophen/caffeine combination pills. […] Primary care physicians should consider preventive treatment for patients with four or more headache days per month, or for patients with fewer than four headaches/month if these are severe enough to cause significant life impairment. […] Preventive medications include topiramate, beta-blockers, monoclonal antibodies, tricyclic antidepressants, and botulinum toxin for chronic migraine. […] Headache in pediatrics is a common and an increasing problem. Pediatricians have an abundance of treatments to try before referral to a specialist.

• #2 Pediatric Headache Treatment & Management: Approach Considerations, Treatment of Migraine and Tension-Type Headaches, Treatment of Chronic Daily Headache

  https://emedicine.medscape.com/article/2110861-treatment

  Anticonvulsants such as valproic acid, zonisamide, and topiramate have been used as prophylactic agents with reasonable success. […] Chronic, intermittent analgesic use may result in medication-overuse headaches. […] Psychological, behavioral, and relaxation interventions are also beneficial. […] The treatment of sinusitis includes appropriate antibiotic coverage, as well as the use of analgesics (eg, NSAIDs, acetaminophen) and nasal decongestants. […] Inpatient care is provided for individuals with CDH after outpatient treatment has failed.

• #2 Pediatric Headache Treatment & Management: Approach Considerations, Treatment of Migraine and Tension-Type Headaches, Treatment of Chronic Daily Headache

  https://emedicine.medscape.com/article/2110861-treatment

  Stress, as a trigger and as a consequence of headache, is a logical target for nonpharmacologic therapy. […] Patients who are prone to tension headaches should attempt to minimize stress and may benefit from behavioral/relaxation therapy. […] Consider prophylactic therapy when headaches are frequent enough to interfere with the patient’s lifestyle. […] In general, the effect of prophylactic therapy is not immediate, often taking as long as 6-8 weeks before improvement occurs. […] Migraines are known to remit spontaneously in some patients during childhood. […] Beta-blockers are commonly used as prophylactic therapy for childhood migraine; propranolol and nadolol are each effective. […] Tricyclic agents (amitriptyline, nortriptyline) are frequently used for prophylactic therapy, especially in older children and adolescents.

• #2 Frontiers | Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade?

  https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00771/full

  Here, our aim is to investigate the actual evidence concerning prophylactic therapy of pediatric migraine by reviewing clinical studies published between 2010 and 2019. […] Flunarizine is a calcium channel blocker with properties on the cerebrovascular circulation. […] Propranolol is a non-selective beta (b) adrenoceptor antagonist that blocks the b1,2 receptors. […] Amitriptyline is one of the most used drugs for preventive treatment of pediatric migraine. […] Sodium Valproate (500–1,500 mg/day) and topiramate (50–100 mg/day) were evaluated for prophylactic therapy of pediatric migraine in some controlled studies. […] Pizotifen was studied in a placebo controlled trial conducted on 37 subjects (6–15 years), at a dosage of 1.5 mg/day, with a significant reduction in attack frequency and mild side effects.

• #2

  https://www.healthychildren.org/English/health-issues/conditions/treatments/Pages/Natural-Therapies-for-Children-with-Chronic-Headaches.aspx

  Massage therapy may be helpful for a child with chronic daily headaches and includes a variety of techniques in which practitioners manipulate the soft tissues of the body. […] Acupuncture may also benefit a child with headaches. […] Biofeedback is one of the treatments researched most extensively for migraines. […] Guided imagery, self-hypnosis, or relaxation can be helpful for preventing headaches. […] All dietary supplements should be discussed with the child’s pediatrician before use. […] Riboflavin is a B-vitamin that may reduce the number of headaches and pain. […] Magnesium supplements may also help reduce the number of headaches if taken for several months. […] Coenzyme Q10 (CoQ10) is an antioxidant present in each cell of our bodies; however, it was found to be deficient in one third of children with migraines. […] Butterbur is an herb extract that may reduce the number and severity of migraine headaches. […] If you’ve made the decision to seek a natural therapy for your child’s headaches, it is of utmost importance to involve your child’s pediatrician in the process.

• #2 Behavioral management of headache in children and adolescents | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-016-0671-4

  Psychological treatments are essential elements of the multidisciplinary, bio-psychosocial management of primary headache disorders, particularly for those with frequent or chronic headache, a high level of headache-related disability, medication overuse, or comorbid psychiatric symptoms. […] Teaching relaxation techniques, stress reduction, increasing physical activity, and other psychological interventions should be considered standard management options for children with headache and other comorbidities. […] Cognitive behavioral therapy is a treatment that targets behaviours, emotions, and cognitions that trigger or aggravate headaches. […] Behavioral interventions provide a treatment option that can enhance or if necessary, replace pharmacotherapy. […] The combination of both pharmacological and non-pharmacological treatment has been shown to be superior to each individually, and appears to maximize long-term therapeutic benefit of treatment.

• #2 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  Management of chronic headaches requires a coordinated approach with the child’s clinician and should be individualized according to the needs of the child; clear guidelines regarding the use of acute medications should be discussed. […] Lifestyle changes are often necessary to terminate chronic headache. These include drinking an adequate amount of fluids, eating a healthy diet, reducing or eliminating caffeine, getting regular exercise, eating and sleeping on a regular schedule, and refraining from smoking. […] Prevention therapies are usually indicated if the headaches are occurring more than one to two times per week. This may include medications such as antidepressants – especially tricyclic antidepressants, antiseizure medications (such as topiramate [brand name: Topamax] or valproate [brand name: Depakote), blood pressure medications (such as beta-blocker or calcium channel blockers), or antihistamines. One study demonstrated that amitriptyline, topiramate, and placebo were all effective in preventing children’s migraines.

• #2 Headaches in Children: Causes, Types & Pain Relief

  https://my.clevelandclinic.org/health/diseases/4225-headaches-in-children

  Your healthcare provider may teach your child about certain headache triggers. Common triggers include: Lack of sleep. Specific foods. Caffeinated drinks (tea, coffee, soda). […] To reduce the risk of headaches, make sure your child gets: Eight hours of sleep every night. Six eight-ounce glasses of water every day. Three healthy meals every day. Cardio exercise (45 minutes, three times a week). Relaxation. […] Learning relaxation techniques can help reduce the pain and/or frequency of your childs headaches. Stress management techniques may include: Deep breathing exercises. Mindfulness or meditation. Mental imagery relaxation. Music therapy. Counseling. […] Avoiding triggers and taking preventative medications can help reduce the risk of headaches. […] Discuss the severity and frequency of the headaches with your childs healthcare provider. They may have recommendations regarding school/daycare. […] If your child is struggling with headaches, schedule an appointment with your healthcare provider right away.

• #2 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  One of the more effective treatments for chronic migraine is CBT combined with amitriptyline. Most children can benefit from this within four to six weeks and will have a sustained positive result. […] Some children with chronic headaches stop attending school or other normal daily activities. It is important to encourage the child to return to these activities as a part of treatment. If necessary, the child can be allowed to lie down in the school nurse’s office for a brief period (eg, 15 minutes once daily) when headache pain is worst.

• #2 Chronic Headaches in Children | Duke Health

  https://www.dukehealth.org/treatments/pediatric-neurology/chronic-headaches-children

  Botulinum toxin A (Botox) treatments may be recommended for children age 12 and older who have chronic migraine headaches that have not responded to other treatments. […] Vitamins and supplements may play a role in reducing the severity and frequency of headaches. Biofeedback, acupuncture, yoga, physical therapy, and mindfulness training may also be recommended. […] We help create a Migraine Action Plan to ensure that your child receives prompt treatment at school at the earliest signs of a migraine. The plan helps office staff and school nurses determine quickly if your child needs prescribed medicine, so a headache doesnt progress and cause your child unnecessary pain or significant missed class time. […] Our pediatric neurologists, headache pediatric nurse practitioner/pediatric mental health specialist, and social worker are able to help most children who follow a care plan to reduce headache frequency and severity.

• #2 Pediatric Headache Treatment & Management: Approach Considerations, Treatment of Migraine and Tension-Type Headaches, Treatment of Chronic Daily Headache

  https://emedicine.medscape.com/article/2110861-treatment

  Triptans may be helpful in the treatment of these headaches, especially if the onset of headache has been recent. […] Sleep, darkness, and a quiet room are essential in managing acute migraine and tension-type headache. […] Individual treatment decisions should be based on the age of the child and receptiveness to behavioral techniques. Behavioral techniques can be highly effective for migraine and tension-type headaches. […] Acute tension headaches often respond to symptomatic treatments. Ibuprofen and acetaminophen are recommended to relieve headache pain. […] The role of diet in headaches remains controversial. However, if a given food or beverage is associated with headaches, its avoidance has an obvious and significantly positive impact. […] Regular sleep schedules, especially adequate amounts of sleep, have an effect on migraine control.

• #2 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics

  Other suggestions include the following: […] Frequent or chronic TTH — If a child has frequent or chronic TTH (ie, ≥15 headache days per month), the first line of treatment is an OTC rescue pain medication, such as children’s acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). Aspirin is not recommended in children who are less than 18 years due to the risk of a rare but serious condition called Reye syndrome. […] Migraine treatment […] General measures — Although many triggers have been suspected to induce, promote, or sustain an attack of migraine, the specific factors that trigger attacks can differ from one person to another and may be inconsistent between attacks. Mobile phone apps can closely track potential triggers to help identify specific triggers for individual patients. A partial list of potential triggers appears in the table (table 1). Children who have frequent or severe attacks should keep a record of their headaches in a headache diary. This can help to determine if a specific pattern or exposure can be avoided to prevent future headaches.

• #2

  https://www.boystownpediatrics.org/knowledge-center/headaches

  Children, like adults, often suffer from mild acute or recurrent headache pain. […] Many children suffer from recurrent headaches caused by tension. […] Tension headaches in children frequently occur from prolonged use of video games, computers or other sedentary activities that cause improper posture for an extended period. […] To ease pain caused by acute headaches, try the following remedies. […] To reduce the pain of a tension headache, try the following tactics. […] Mild acute headaches do not normally require medical attention. […] Many headaches caused by illness come and go, but tension headaches recur and can last from a few hours to a day or longer. […] If your child is experiencing recurrent headaches, he or she should be evaluated by a medical professional. […] Another reason to seek medical attention would be if your child is experiencing severe headaches that are causing them to withdraw from activity, have light and/or noise sensitivity or have nausea and/or vomiting.

• #2 Kids and migraines: How a pediatric neurologist can help | Pediatrics | UT Southwestern Medical Center

  https://utswmed.org/medblog/child-migraines-treatment-experts/

  Migraines can be debilitating for a child or teen. The neurologist-led pediatric migraine team at UT Southwestern offers the most advanced treatments and prevention strategies for children with migraines. […] Not every patient will become migraine-free. But getting an accurate diagnosis and sticking to a neurologist-guided PedMAP can give your child more headache-free days, fewer emergency room trips, and a more enjoyable experience at home and school. […] The pediatric migraine action plan will help kids stay on track with migration prevention. It’s also a guide for how to seek and provide appropriate, timely treatment when migraines strike at home and school. […] Your child’s PedMAP will include best practices for migraine management, as well as spaces to enter appropriate treatments and medication doses. There are many effective treatment options for pediatric migraine, depending on your child’s condition and their ability to participate in their own care.

• #2 Paediatric Primary Headache: Pharmacological and Non-Pharmacological Treatments – European Medical Journal

  https://www.emjreviews.com/neurology/article/paediatric-primary-headache-pharmacological-and-non-pharmacological-treatments/

  Headaches are common in children and adolescents, and are the most common pain complaint when seeking medical advice. Primary headaches are one of the most common disorders of childhood, with migraine and tension type headache being the most prominent. Treatment strategies for primary headaches vary according to patients age, family structure, culture and beliefs, headache diagnosis, and according to the disability the headache imposes on the patients daily living. A multidisciplinary treatment approach was found to be an effective strategy for children and adolescents; it was shown to improve multiple outcome variants, including frequency and severity of headache, and school days missed because of headache. […] Treatment strategies for primary headaches vary according to patients age, family structure, culture and beliefs, headache diagnosis, and according to the disability the headache imposes on the patients daily life. A multidisciplinary treatment approach was found to be an effective strategy for children and adolescents, improving multiple outcome variants, including frequency and severity of headache, and school days missed because of headache.

• #3 Pediatric Headache Treatment & Management: Approach Considerations, Treatment of Migraine and Tension-Type Headaches, Treatment of Chronic Daily Headache

  https://emedicine.medscape.com/article/2110861-treatment

  Triptans may be helpful in the treatment of these headaches, especially if the onset of headache has been recent. […] Sleep, darkness, and a quiet room are essential in managing acute migraine and tension-type headache. […] Individual treatment decisions should be based on the age of the child and receptiveness to behavioral techniques. Behavioral techniques can be highly effective for migraine and tension-type headaches. […] Acute tension headaches often respond to symptomatic treatments. Ibuprofen and acetaminophen are recommended to relieve headache pain. […] The role of diet in headaches remains controversial. However, if a given food or beverage is associated with headaches, its avoidance has an obvious and significantly positive impact. […] Regular sleep schedules, especially adequate amounts of sleep, have an effect on migraine control.

• #3 Pediatric Headache Medication: Analgesics, Other, Sedative/Hypnotics, Serotonin 5-HT-Receptor Agonists, Antiemetic Agents, Beta-Blockers, Tricyclic Antidepressants, Anticonvulsants, Calcium Channel Blockers, Antihistamines, Corticosteroids, Carbonic Anhyd

  https://emedicine.medscape.com/article/2110861-medication

  Amitriptyline has efficacy for migraine prophylaxis that is independent of its antidepressant effect. Its mechanism of action is unknown, but it inhibits the activity of such diverse agents as histamine, 5-HT, and acetylcholine. […] Divalproex sodium is a stable coordination compound composed of sodium valproate and valproic acid in a 1:1 molar relationship; it has been approved by the FDA for prevention of migraine in children older than 12 years. […] Gabapentin is used for migraine headache prophylaxis. […] Topiramate is sedating and causes cognitive slowing if the dose is advanced rapidly or the starting dose is high.

• #3 Non-medical treatment of headache and migraine in children and young people | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/procedures-and-treatments/non-medical-treatment-headache-and-migraine-children-and-young-people/

  Acupuncture is regarded as safe when carried out by a qualified practitioner. […] The National Institute for Health and Clinical Excellence (NICE) has recommended acupuncture for treating chronic headaches and migraines in children over 12 years of age. […] Transcranial magnetic stimulation is not suitable for anyone with metal in their head or neck. […] NICE have recommended transcranial magnetic stimulation as an approved treatment for headache and migraine in adults. […] Vagus nerve stimulation has been reported to cause headache and dizziness after using, alongside neck stiffness and pain in the mouth, throat and shoulder. […] NICE have recommended vagus nerve stimulation as an approved treatment for headache and migraine in adults. […] Research has shown that supraorbital and occipital nerve stimulation is relatively safe with a small number of people suffering side effects.

• #3

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut2288

  Kids get migraine headaches too. […] Without treatment, your child’s migraine headache can last 2 to 72 hours. For most children, migraine headaches return from time to time. Home treatment can help reduce how often and how uncomfortable the migraine headaches are. […] Begin home treatment at the first sign of a migraine. Your child should go to a quiet, dark place and relax. Most headaches will go away after rest or sleep. […] If your doctor has prescribed medicine to stop your child’s migraines, have your child take it at the first sign of a migraine. This can help stop the headache before it gets worse. […] If your doctor has not prescribed medicine for your child’s migraines, give your child a pain reliever, such as children’s acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). Have your child take the medicine at the first sign of a migraine. This can help stop the headache before it gets worse.

• #3 Is Your Child a Migraine Sufferer? Ways You Can Help | Children’s Hospital Los Angeles

  https://www.chla.org/blog/advice-experts/your-child-migraine-sufferer-ways-you-can-help

  Wendy Mitchell shares these additional migraine prevention methods: Keep a headache journal or diary to help identify triggers, depending on how often your child gets headaches. […] When discussing headaches with your childs doctor, expect to discuss their mental and physical health. It will be important in obtaining the most effective course of treatment. […] So, the next time your child says their head hurts, dont ignore it.

• #3

  https://www.boystownpediatrics.org/knowledge-center/headaches

  Call your child’s physician immediately or go to your nearest Emergency Department if: Pain is severe and persists more than two hours after your child takes pain medication. […] Your child has difficulty with vision, thinking, speech or walking. […] Your child’s neck is stiff or your child is acting very sick.

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