Migraine is disabling condition which is characterized by episodic headaches with moderate to severe intensity affecting nearly 8 % of the children and adolescents but is under recognized and under reported especially in children and even in an adolescent population. Nearly 1/3 of the patients, first experience migraine in childhood or adolescence, of which half continue to have migraines in adulthood. Thus early diagnosis and therapy in childhood give us a window of opportunity to address the problem which can go a long way in improving the long term course of migraine.
How do we diagnose Migraine?
The diagnosis is purely clinical and there is no special test, lab bio-marker or radiological investigation to diagnose the condition. History and physical examination are done to establish the diagnosis by the criterion laid by ICHD- International classification of headache disorders.
What are the associated conditions with Migraine?
Children with migraine are more likely than the general population to have medical conditions like epilepsy (Predisposition to have recurrent seizures), obesity, asthma, anemia, anxiety depression, attention deficits. This suggests that treatment while treatment it’s imperative that associated chronic problems need to be addressed.
Acute Treatment: NSAIDs(Non-steroidal inflammatory drugs ) are the first line treatment for the severe headache attacks and if not relieved with NSAIDs then Triptans can be used with a combination of NSAID and Triptans reserved for the children who do not respond to either of them individually. It is however emphasized not to use the abortive therapy more than 3 times a week to avoid the overuse threshold of 15 days per month which if continued for more than 3 months can further worsen the headache; an entity is known as Medication overuse headache, thus medication should be taken only under supervision.
Life style Modification: Development of healthy habits and coping techniques go a long way in managing this condition throughout life. These include sleep hygiene i.e, regular sleep hours, regular meals- 5 small meals per day to avoid being empty stomach, plenty of oral fluids, regular exercise for weight reduction, stress management.
Along with life style modifications psychological interventions like biofeedback, relaxation techniques and Cognitive Behavioral therapy (CBT). These techniques help in modifying maladaptive thoughts, emotions and behavior by reinforcing positive thinking, reducing stress and have a calming effect on the mind and increasing the threshold for migraine triggers.
Children who continue to have headaches four or more per month despite the above interventions may benefit from prophylaxis- which is a daily intake of preventive medications to reduce the severity and frequency of the attacks.
Thus Pediatric migraine management involves a multi-disciplinarian approach with early diagnosis and management, improve pain coping skills and reduce the risk of chronic migraine and behavioral modification to get best results.
Dr. Sahil Kohli, is a Consultant Neurology at, Narayana Superspeciality Hospital in Gurugram
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