ABSTRACT
Advances in the management of headache for adults have translated into improved treatment for children and adolescents. Studies conducted in children and adolescents are helping us to outline the appropriate management strategies for this population (1). Practitioners should review the causative mechanisms of headache with the patient and the parents, as well as provide a comprehensive treatment approach, including both pharmacologic and nonpharmacologic methods. The majority of childhood headache patients who are brought to a physician for evaluation will prove to have a diagnosis of migraine (2,3). To effectively treat headache (migraine), the physician initially needs to identify potential triggers and outline an acute treatment strategy with a goal of eliminating headache in one to two hours. If the initial medication is not fully effective, the physician needs to consider either repeating the initial medication or starting a possible rescue medication with the goal of eliminating all pain symptoms by four hours. In this age group, especially children under the age of 12, headache may last only for one to two hours. In this case, a more moderate approach toward treatment and pain relief can be used (1-7). When appropriate, preventive treatment strategies should be designed with a goal of substantially reducing headache frequency (at least 50%), with a possible reduction of the headache severity. Moreover, they should be used on an average for six-month periods, with reevaluation. Because there is a relatively high remission rate of migraine in children, it is often possible to taper a preventive regimen within six months of its initiation (1).
