From the Guidelines
Pediatric headache treatment should prioritize non-pharmacological approaches and ibuprofen as the first-line medication for acute treatment, due to its efficacy and safety profile in children, as supported by recent guidelines 1.
Key Considerations
- Non-pharmacological approaches, including adequate hydration, regular sleep patterns, stress reduction, and identifying potential triggers, are essential for managing pediatric headaches.
- For acute treatment, ibuprofen is recommended as the first-line medication, with a dose appropriate for body weight, as it has been shown to be effective in reducing headache symptoms in children 1.
- In adolescents aged 12-17 years, triptans like sumatriptan (10 mg nasal spray) may be considered for migraine-specific treatment, as they have been approved for acute treatment of migraine in this age group 1.
- Preventive treatments, such as amitriptyline or topiramate, may be considered for children with frequent or severe headaches, although their effectiveness in children and adolescents has not been proven in clinical trials 1.
Additional Guidance
- Children with warning signs, such as early morning headaches, positional headaches, neurological symptoms, or headaches that wake them from sleep, should be evaluated promptly, as these may indicate serious underlying conditions.
- Keeping a headache diary to track frequency, intensity, triggers, and response to treatments can help guide management and should be reviewed regularly with the healthcare provider.
- Recent guidelines from the American College of Physicians 1 support the use of NSAIDs, acetaminophen, or combination therapy for acute treatment of migraine in adults, but the evidence base for pediatric headache treatment is limited, and ibuprofen remains the recommended first-line medication for acute treatment in children.
From the Research
Pediatric Headache Treatment
- The approach to pediatric headache treatment involves a comprehensive assessment, including a detailed headache history, physical and neurological examinations, and diagnostic evaluation 2, 3, 4, 5, 6.
- Primary headache types in children include migraine and tension-type headache, while secondary headache causes can be due to infections, trauma, vascular disorders, substance use/withdrawal, and psychiatric conditions 2, 4, 5.
- The American Academy of Neurology (AAN) guidelines recommend against routine lab studies, lumbar puncture, electro-encephalogram (EEG), or neuroimaging in patients with no headache red flags by history and a normal neurologic examination 2.
- Treatment modalities for pediatric headache include lifestyle modifications, behavioral techniques, and abortive and preventive medications 3, 4.
- A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, as children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms 5.
Diagnosis and Evaluation
- The evaluation of headache must be directed primarily to exclude secondary causes, and a detailed headache history, recognition of headache patterns and red flags, and thorough physical and neurological examinations are essential in the diagnosis 6.
- Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting, and headache associated with straining 5.
- Neuroimaging and ancillary testing should be considered in patients with red flags or abnormal physical and neurological examinations 2, 6.
Treatment Options
- Lifestyle modifications, such as stress management and sleep hygiene, can be effective in reducing headache frequency and severity 3, 4.
- Behavioral techniques, such as cognitive-behavioral therapy, can also be helpful in managing pediatric headache 3, 4.
- Abortive and preventive medications, such as triptans and anticonvulsants, can be used to treat acute headache episodes and prevent future headaches 3, 4.