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Migraine in Primary Care Advisors

MIPCA Projects

Managing children with headache

This project produced guidelines for the management of headache in children. Childhood migraine is a common disorder that may present, at least initially, with symptoms atypical to those of the adult form. The diagnostic procedure needs to recognise these signs, as well as the more typical headache and non-headache symptoms, if it is to be successful. The best driver of treatment need is the impact the headache has on the patient’s daily life. Treatment options are more limited than those available for adults, but most children can be provided with an effective acute medication. Paracetamol and ibuprofen can be recommended as initial therapies, with sumatriptan nasal spray reserved for rescue. Prophylactic medications are more problematic, and probably best avoided by the GP. Long-term follow up is essential to monitor the progress of the illness to resolution, or to the development of adult-type symptoms.

For management to be successful, healthcare professionals need to liaise with the patient, their parents and peers, and with teaching professionals. Using these methods, the GP can provide effective management for the majority of children with migraine.

Management of children with chronic headaches offers more challenges to the GP, and patients are probably best referred to a specialist physician. The GP should consider substance abuse as a possible cause of these headaches.

Reference

Dowson AJ, Lipscombe S, Carter F et al. Managing children and adolescents with migraine and other headaches: scientific and clinical aspects. Headache Care 2005;2:193–207

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