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1、Diagnosis and Treatment of Pediatric Migraine,Susan LeCates, MSN, CNP Family Nurse Practitioner Neurology Department / Headache CenterCincinnati Childrens Hospital Medical Center,Disclosure,The content of my presentation will include discussion of unapproved or investigational uses of medication for
2、 acute and preventative treatment of migraine headache in children,Objectives,Understand diagnosis of primary headache in children using the International Classification of Headache Disorders (ICHD-3)Develop an appropriate treatment plan for children diagnosed with migraine headachesRecognize when t
3、o refer children with migraine headaches,Migraines are Common,There are 28 million people in the world with MigraineMigraines occur at all agesMigraine headaches in children and adolescents are often under recognized or NOT taken seriouslyHeadache 1993;33:29-35,Migraine Prevalence in Childhood,3 to
4、7 year olds,Migraine Prevalence in Childhood,7 to 11 year olds,=,Migraine Prevalence in Childhood,11 to 15+ year olds, 3 months, which has the features of migraine headache on at least 8 days per monthOften results from unresolved status migrainosusNot attributed to another disorder,Status Migrainos
5、us ICHD-3, 2013,Present attack meets criteria for migraine without aura and is typical of other attacksBoth of the following HA 72 hours Severe intensityNot attributed to another disorderInterruption during sleep and short lasting relief due to medication are disregarded,Challenges of Treating Pedia
6、tric Migraine,Diagnosis and assessment of symptoms is complicated by the inability of children to articulate their complaintsOther infectious, allergic, or gastrointestinal disorders of childhood may mimic symptoms of migraineLack of research conducted in children and adolescents,If It Isnt Migraine
7、 What Is It?,Headache Attributed to Infection of Nose or Paranasal Sinuses ICHD-3, 2013,Frontal HA with pain in one or more regions of face, ears or teethClinical, nasal exam, CT and/or MRI imaging and/or lab evidence of acute or acute-on-chronic rhinosinusitisSimultaneous onset of headache and faci
8、al painHeadache and/or facial pain resolve within 7 days after successful treatment,Episodic Tension-Type ICHD-3, 2013,At least 10 attacks (more than once but less than 15 days/mos)HA lasting from 30 minutes to 7 daysAt least 2 of the following: Pressing/tightening quality Mild or moderate intensity
9、 Bilateral location Not aggravated by routine physical activity,Episodic Tension-Type ICHD-3, 2013,Both of the following: No nausea or vomiting (anorexia may occur) Photophobia or phonophobiaNot attributed to another disorder,Medication-Overuse Headache ICHD-3, 2013,Analgesics at least 15 days/mos f
10、or 3 mosTriptans at least 10 days/mos for 3 mosHA has developed or markedly worsened during analgesic overuseHeadache resolves or reverts to previous pattern within 2 months after stopping analgesics,Daily low dose medication use worse than high dose use once a weekCaffeine can also be culprit,Medic
11、ation-Overuse Headache Vasconcellos, et al, 1997,Retrospective review of pts 4 HA/wk N = 98, mean age = 12.1Frequency of HA per month Initial = 27.5 After 1 mo. without analgesics = 7.3 After 2 mo. without analgesics = 5.4 (P0.0001)Daily use of analgesics may reduce the effectiveness of preventative HA meds,
