How is hemiplegic migraine treated in children?

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

For acute treatment of hemiplegic migraine, antiemetics, mild sedatives, and nonnarcotic pain relievers are generally safe. However, vasoconstrictors, triptans, and ergotamine preparations are contraindicated.

For long-term prophylaxis, any of the agents used to prevent typical migraines may also be used to prevent hemiplegic migraines. Beta blockers, low-dose TCAs, low-dose daily aspirin (stopped during febrile illnesses), low-dose anticonvulsants, and calcium channel blockers can be administered. For a few patients with specific channelopathies, acetazolamide (Diamox) can be used to prevent attacks.

Flunarizine, a calcium channel blocker that is not available in the United States, 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 and with or without herbs (eg, feverfew).


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