Childhood Migraine Variants Treatment & Management

  • Author: Wendy G Mitchell, MD; Chief Editor: Amy Kao, MD   more...
 
Updated: Oct 19, 2011
 

Medical Care

The first step in treatment is to establish the diagnosis. When attacks have occurred on multiple occasions, with complete resolution between attacks, particularly in the presence of a positive family history of migraine, extensive laboratory evaluations and imaging can be avoided. When the child is first seen acutely, particularly during the first episode, more extensive evaluation may be necessary to exclude alternative diagnoses. Treatment can be divided into the short-term care of the specific attack and long-term medication to reduce severity or frequency of episodes. Notably, no agents have adequate clinical trials to establish safety and efficacy for either relief or prevention of migraine in preadolescent patients. All treatment is based upon weaker, often anecdotal evidence.

  • Hemiplegic migraine
    • Acute treatment: Antiemetics, mild sedatives, and nonnarcotic pain relievers are generally safe. However, vasoconstrictors, triptans, and ergotamine preparations are contraindicated.
    • Chronic prevention: Any of the agents used to prophylax migraine have been used for hemiplegic migraines; beta-blockers, low-dose tricyclics, low-dose daily aspirin (stopping during febrile illnesses), low-dose anticonvulsants, and calcium channel blockers can be administered. Flunarizine, a calcium channel blocker not available in the US, is probably the most effective agent for true alternating hemiplegia of childhood. Nonprescription alternative agents sometimes used for prevention include high-dose riboflavin, with or without magnesium supplementation, with or without herbals (feverfew).
  • Cyclic vomiting of childhood
    • Acute treatment: If mitochondrial cytopathy or organic aciduria is suggested or diagnosed, tailor treatment to the underlying disorder. In general, early use of IV fluids containing adequate glucose (to prevent a catabolic state), parenteral or rectal antiemetics, and analgesics may abort the attack. Some patients respond to the triptans or ergotamine classes of medication.
    • Chronic prevention: Low-dose amitriptyline can be effective. Other antimigraine agents (eg, beta-blockers, anticonvulsants, calcium channel blockers) occasionally are useful. If serum carnitine is low, consider a trial of supplementation with l-carnitine. Some patients report improvement with mitochondrial cocktails of high-dose B vitamins and coenzyme Q10. There is no firm evidence for these measures.
Next

Consultations

If an underlying metabolic disease, mitochondrial cytopathy, or inborn error of metabolism is suggested clinically, consult with a medical geneticist with expertise in metabolic disease.

Previous
Next

Diet

  • As for all migraineurs, diet, particularly certain chemicals in food, may precipitate attacks in some patients.
  • Patients should keep a detailed diary of food, activities, and episodes in an attempt to identify precipitant(s).
  • Rather than embarking on elimination diets, which are unlikely to be helpful, a trial of elimination may be useful if a particular food or additive is suspected as a trigger for the attacks.
Previous
Next

Activity

  • Some migraineurs experience attacks related to specific activities or exposures.
  • The most common identifiable and avoidable precipitant is glare and/or flashing lights. Encourage children who are sensitive to glare to wear sunglasses when outdoors and to avoid strobes and strobelike conditions.
Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Wendy G Mitchell, MD  Professor of Neurology, University of Southern California School of Medicine; Consulting Staff, Division of Child Neurology, Children's Hospital Los Angeles, Los Angeles County-University of Southern California

Wendy G Mitchell, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, Child Neurology Society, and International Child Neurology Association

Disclosure: Nothing to disclose.

Specialty Editor Board

James J Riviello Jr, MD  George Peterkin Endowed Chair in Pediatrics, Professor of Pediatrics, Section of Neurology and Developmental Neuroscience, Professor of Neurology, Peter Kellaway Section of Neurophysiology, Baylor College of Medicine; Chief of Neurophysiology, Director of the Epilepsy and Neurophysiology Program, Texas Children's Hospital

James J Riviello Jr, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Up To Date Royalty Section Editor

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Kenneth J Mack, MD, PhD  Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Amy Kao, MD  Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

References

  1. Hansen JM, Hauge AW, Ashina M, Olesen J. Trigger factors for familial hemiplegic migraine. Cephalalgia. Sep 2011;31(12):1274-81. [Medline].

  2. Ahmed MA, Reid E, Cooke A, et al. Familial hemiplegic migraine in the west of Scotland: a clinical and genetic study of seven families. J Neurol Neurosurg Psychiatry. Dec 1996;61(6):616-20. [Medline].

  3. Ahonen K, Hamalainen ML, Rantala H, Hoppu K. Nasal sumatriptan is effective in treatment of migraine attacks in children: A randomized trial. Neurology. Mar 23 2004;62(6):883-7. [Medline].

  4. Baloh RW, Honrubia V. Childhood onset of benign positional vertigo. Neurology. May 1998;50(5):1494-6. [Medline].

  5. Beauvais K, Cave-Riant F, De Barace C, et al. New CACNA1A gene mutation in a case of familial hemiplegic migraine with status epilepticus. Eur Neurol. 2004;52(1):58-61. [Medline].

  6. Blaik Z, Hiremagular S. Episodic unilateral mydriasis and headaches. Tenn Med. Mar 1998;91(3):107-8. [Medline].

  7. Boles RG, Adams K, Ito M, Li BU. Maternal inheritance in cyclic vomiting syndrome with neuromuscular disease. Am J Med Genet A. Aug 1 2003;120(4):474-82. [Medline].

  8. Ducros A, Joutel A, Vahedi K, et al. Mapping of a second locus for familial hemiplegic migraine to 1q21-q23 and evidence of further heterogeneity. Ann Neurol. Dec 1997;42(6):885-90. [Medline].

  9. Evans RW, Taylor FR. "Natural" or alternative medications for migraine prevention. Headache. Jun 2006;46(6):1012-8. [Medline].

  10. Evers S, Rahmann A, Kraemer C, et al. Treatment of childhood migraine attacks with oral zolmitriptan and ibuprofen. Neurology. Aug 8 2006;67(3):497-9. [Medline].

  11. Freitag FG, Collins SD, Carlson HA, et al. A randomized trial of divalproex sodium extended-release tablets in migraine prophylaxis. Neurology. Jun 11 2002;58(11):1652-9. [Medline].

  12. Gardner K, Barmada MM, Ptacek LJ, Hoffman EP. A new locus for hemiplegic migraine maps to chromosome 1q31. Neurology. Nov 1997;49(5):1231-8. [Medline].

  13. Golomb MR, Sokol DK, Walsh LE, et al. Recurrent hemiplegia, normal MRI, and NOTCH3 mutation in a 14-year-old: is this early CADASIL?. Neurology. Jun 22 2004;62(12):2331-2. [Medline].

  14. Haan J, Terwindt GM, Maassen JA, et al. Search for mitochondrial DNA mutations in migraine subgroups. Cephalalgia. Jan 1999;19(1):20-2. [Medline].

  15. Jurkat-Rott K, Freilinger T, Dreier JP, et al. Variability of familial hemiplegic migraine with novel A1A2 Na+/K+-ATPase variants. Neurology. May 25 2004;62(10):1857-61. [Medline].

  16. Kim JS, Yue Q, Jen JC, et al. Familial migraine with vertigo: no mutations found in CACNA1A. Am J Med Genet. Sep 1 1998;79(2):148-51. [Medline].

  17. Lampl C, Buzath A, Klinger D, Neumann K. Lamotrigine in the prophylactic treatment of migraine aura--a pilot study. Cephalalgia. Jan 1999;19(1):58-63. [Medline].

  18. Lendvai D, Monteleone F, Melpignano G, et al. Familial hemiplegic migraine in developmental age: report of two cases. Riv Eur Sci Med Farmacol. Jul-Aug 1996;18(4):143-7. [Medline].

  19. Lewis D, Ashwal S, Hershey A, et al. Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology. Dec 28 2004;63(12):2215-24. [Medline].

  20. Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. Aug 27 2002;59(4):490-8. [Medline].

  21. Li BU, Murray RD, Heitlinger LA, et al. Heterogeneity of diagnoses presenting as cyclic vomiting. Pediatrics. Sep 1998;102(3 Pt 1):583-7. [Medline].

  22. Li BU, Murray RD, Heitlinger LA, et al. Is cyclic vomiting syndrome related to migraine?. J Pediatr. May 1999;134(5):567-72. [Medline].

  23. Lipton RB. Diagnosis and epidemiology of pediatric migraine. Curr Opin Neurol. Jun 1997;10(3):231-6. [Medline].

  24. Mark AS, Casselman J, Brown D, et al. Ophthalmoplegic migraine: reversible enhancement and thickening of the cisternal segment of the oculomotor nerve on contrast-enhanced MR images. AJNR Am J Neuroradiol. Nov-Dec 1998;19(10):1887-91. [Medline].

  25. Nezu A, Kimura S, Ohtsuki N, et al. Acute confusional migraine and migrainous infarction in childhood. Brain Dev. Mar 1997;19(2):148-51. [Medline].

  26. O'Hara MA, Koller HP. Migraine in a pediatric ophthalmology practice. J Pediatr Ophthalmol Strabismus. Jul-Aug 1998;35(4):203-8; quiz 227-8. [Medline].

  27. Ojaimi J, Katsabanis S, Bower S, et al. Mitochondrial DNA in stroke and migraine with aura. Cerebrovasc Dis. Mar-Apr 1998;8(2):102-6. [Medline].

  28. Ophoff RA, Terwindt GM, Vergouwe MN, et al. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2+ channel gene CACNL1A4. Cell. Nov 1 1996;87(3):543-52. [Medline].

  29. Ramelli GP, Sturzenegger M, Donati F, Karbowski K. EEG findings during basilar migraine attacks in children. Electroencephalogr Clin Neurophysiol. Nov 1998;107(5):374-8. [Medline].

  30. Rothner AD, Winner P. Headaches in children and adolescents. Wolff's Headache and other head pain. 2001;539-561.

  31. Schreier HA. Auditory hallucinations in nonpsychotic children with affective syndromes and migraines: report of 13 cases. J Child Neurol. Aug 1998;13(8):377-82. [Medline].

  32. Shaabat A. Confusional migraine in childhood. Pediatr Neurol. Jul 1996;15(1):23-5. [Medline].

  33. Soriani S, Feggi L, Battistella PA, et al. Interictal and ictal phase study with Tc 99m HMPAO brain SPECT in juvenile migraine with aura. Headache. Jan 1997;37(1):31-6. [Medline].

  34. Spranger M, Spranger S, Schwab S, et al. Familial hemiplegic migraine with cerebellar ataxia and paroxysmal psychosis. Eur Neurol. 1999;41(3):150-2. [Medline].

  35. Swoboda KJ, Kanavakis E, Xaidara A, et al. Alternating hemiplegia of childhood or familial hemiplegic migraine? A novel ATP1A2 mutation. Ann Neurol. Jun 2004;55(6):884-7. [Medline].

  36. Terwindt G, Kors E, Haan J, et al. Mutation analysis of the CACNA1A calcium channel subunit gene in 27 patients with sporadic hemiplegic migraine. Arch Neurol. Jun 2002;59(6):1016-8. [Medline].

  37. Ueberall MA, Wenzel D. Intranasal sumatriptan for the acute treatment of migraine in children. Neurology. Apr 22 1999;52(7):1507-10. [Medline].

  38. Vanagaite J, Pareja JA, Storen O, et al. Light-induced discomfort and pain in migraine. Cephalalgia. Nov 1997;17(7):733-41. [Medline].

  39. Welborn CA. Pediatric migraine. Emerg Med Clin North Am. Aug 1997;15(3):625-36. [Medline].

  40. Withers GD, Silburn SR, Forbes DA. Precipitants and aetiology of cyclic vomiting syndrome. Acta Paediatr. Mar 1998;87(3):272-7. [Medline].

  41. Worawattanakul M, Rhoads JM, Lichtman SN, Ulshen MH. Abdominal migraine: prophylactic treatment and follow-up. J Pediatr Gastroenterol Nutr. Jan 1999;28(1):37-40. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.