Pediatric Migraine Clinical Practice Guidelines (AAN/AHS, 2019)

American Academy of Neurology and the American Headache Society

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

October 03, 2019

Guidelines for the prevention and treatment of migraine in children and adolescents were published in 2019 by the American Academy of Neurology (AAN) and American Headache Society (AHS).[1,2]

Prevention

Counsel patients and their caregivers that lifestyle factors, such as poor sleep habits and tobacco use, can contribute to headache frequency and should be modified.

Advise patients and their families that most trials of preventive medications have failed to show any benefit over placebo. A potential exception is propranolol, which may "possibly" result in a 50% reduction in headache frequency in children.

Consider the teratogenic effect of topiramate and valproate when making prevention therapy recommendations to patients of childbearing potential. These drugs may have effects on fetal/childhood development, and topiramate may decrease the efficacy of oral combined hormonal contraceptives.

Recommend daily folic acid supplementation to patients of childbearing potential taking topiramate or valproate.

Screen children and adolescents with migraine for mood and anxiety disorders, as these can increase the risk of headache.

Acute Treatment

Be sure to diagnose a specific headache type when evaluating children and adolescents with headache.

Ask about premonitory and aura symptoms, headache semiology, associated symptoms, and pain-related disability in order to improve diagnostic accuracy.

Counsel patients and their caregivers that treatment is most effective when given early in the attack.

Ibuprofen oral solution (10 mg/kg) should be the initial treatment for children and adolescents. Additionally, adolescents may take triptans, such as sumatriptan/naproxen tablets and zolmitriptan nasal spray.

If one triptan fails to provide pain relief, offer an alternate triptan.

Offer ibuprofen or naproxen in addition to a triptan in adolescents whose migraine is incompletely responsive to a triptan.

Do not prescribe triptans to patients with a history of ischemic vascular disease or accessory conduction pathway disorders.

For patients who also have substantial nausea and vomiting, offer an antiemetic.

Caution patients and their families about medication overuse. For example, ibuprofen should not be used more than 14 days a month, and triptans shouldn't be used more than 9 days a month.

For more Clinical Practice Guidelines, go to Guidelines.

For more information, go to Migraine in Children.

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