How are childhood migraine variants (equivalents) treated?

Updated: Nov 19, 2019
  • Author: Wendy G Mitchell, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Answer

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 (see Workup). When the child is first seen acutely, particularly during the first episode, more extensive evaluation may be necessary to exclude alternative diagnoses.

Treatment of childhood migraine variants has 2 aspects, as follows:

  • Short-term treatment of the specific attack

  • Long-term medication to reduce the 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 on weaker, often anecdotal, evidence. [21, 22]

If the clinical scenario suggests an underlying metabolic disease, mitochondrial cytopathy, or an inborn error of metabolism, consult a medical geneticist with expertise in metabolic disease.


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