What is the role of prophylactic therapy in the treatment of pediatric headache?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Although consensus does not exist regarding the criteria to start prophylactic treatment, frequency and severity will be the main factors to guide the decision. Consider prophylactic therapy when headaches are frequent enough to interfere with the patient's lifestyle. In deciding to begin prophylactic therapy, consider the risks of long-term drug use against the benefit of potential headache relief. The possibility of pregnancy should also be considered if prophylactic medication is prescribed. As with abortive therapy, several classes of pharmacologic agents are available for prophylactic treatment.

In general, the effect of prophylactic therapy is not immediate, often taking as long as 6-8 weeks before improvement occurs. Providing this information to the patient and his/her parents leads to improved compliance and more realistic goals. Giving an appropriate trial before attempting a new treatment is important.

Migraines are known to remit spontaneously in some patients during childhood. Every 6-12 months, reassess the need for continued prophylaxis. This can be achieved by tapering the medication until either the headaches resume or the patient remains headache-free off therapy.

On the other hand, parents and patients need to be aware that migraine headaches may be a lifelong condition, and they should expect that the headaches will reappear at some time during a patient’s lifetime, especially during situations of increased stress, such as puberty, marriage, or change of job.

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