How are pediatric headache symptoms treated?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Drugs used in symptomatic treatment should be chosen carefully according to headache type (eg, beta-blockers or cyproheptadine for migraine, amitriptyline for migraine or tension-type headache), frequency (eg, amitriptyline for more frequent/chronic headache), type of symptoms (cyproheptadine if prominent vomiting), adverse-effect profile (eg, no beta-blockers if asthma). It is advisable to include comorbidities in the choice, such as depression and insomnia, which a tricyclic antidepressant helps to control along with migraine.

Multiple levels of symptomatic therapy exist. The current opinion is that rather than using a step-care treatment starting with the least expensive drugs and then stepping up as needed, the stratified care approach is best; up front the patient situation is assessed and the severity and level of care needed is taken into account to decide on the most effective and overall cost-containing treatment.

Adjusting treatment is recommended until the most efficient regimen is found; this regimen would treat all symptoms, including the headache itself but also other complaints such as nausea, vomiting, and photophobia. Self-treatment can lead to medication-overuse headache. Therapy must be monitored by parents.

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