From the Guidelines
Ibuprofen is the recommended first-line medication for treating headache in pediatric patients, and domperidone can be used for nausea in adolescents aged 12-17 years.
Treatment of Headache and Nausea
- For pediatric patients, ibuprofen is recommended as the first-line medication for treating headache, at a dose appropriate for body weight 1.
- In adolescents aged 12-17 years, domperidone can be used for nausea, although oral administration is unlikely to prevent vomiting 1.
- For acute treatment of migraine in adolescents, sumatriptan/naproxen oral, zolmitriptan nasal, sumatriptan nasal, rizatriptan ODT, or almotriptan oral can be considered 1.
- If nausea or vomiting is present, a non-oral triptan or adding an anti-emetic can be tried 1.
- It's essential to educate family members and teachers on the clinical management of migraine in children and adolescents, as their active help is often required 1.
- Preventive treatments can be considered in children and adolescents with frequent or disabling headaches or medication overuse, and options include amitriptyline, topiramate, and propranolol 1.
From the Research
Treatment Options for Headache and Nausea in Pediatric Patients
- Non-pharmacologic and mindful-based approaches, such as relaxation, mindfulness meditation, yoga, and hypnosis, have shown safety and efficacy data that is promising for the prevention and treatment of headache and migraine in children 2.
- Pharmacological treatments, such as ibuprofen and sumatriptan, are significantly more effective than placebo in determining headache relief 3.
- For mild to severe cases of migraine, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended, with triptans used alone or in combination in moderate to severe headaches unresponsive to over-the-counter therapy 4.
- Anti-emetics with anti-dopaminergic properties can be helpful in patients with associated symptoms of nausea and vomiting along with headache, especially when used in combination therapy 4.
- In the emergency department setting, an initial trial of ibuprofen followed by sumatriptan nasal spray for children over 12 years of age is recommended for those with persistent symptoms, and antiemetics remain an option for those with nausea and/or vomiting as a prominent feature of their illness 5.
Diagnostic Approach
- The initial assessment of a child with headache begins with an in-depth, appropriate history followed by a complete, oriented physical and neurological examination 3.
- Red flags requiring further investigation, such as abnormal neurological examination, atypical presentation of headaches, and recent and progressive severe headache, should be identified 3.
- Diagnostic tests, including routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging, may be necessary to evaluate the cause of the headache 3.
Management and Prevention
- Practice guidelines for prevention of pediatric headache and migraine are now incorporating information and recommendations regarding non-pharmacologic therapeutic options 2.
- Preventative treatment should be initiated early in patients with frequent headaches to improve headache outcomes and quality of life 4.
- Patients and families should be educated on non-pharmacologic management, such as lifestyle modification and avoidance of triggers, that can prevent progression and worsening of migraine 4.