Maryam Oskoui1, Tamara Pringsheim1, Yolanda Holler-Managan1, Sonja Potrebic1, Lori Billinghurst1, David Gloss1, Andrew D Hershey1, Nicole Licking1, Michael Sowell1, M Cristina Victorio1, Elaine M Gersz1, Emily Leininger1, Heather Zanitsch1, Marcy Yonker1, Kenneth Mack1. 1. From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Department of Pediatrics (Neurology) (Y.-H.M.), Northwestern University Feinberg School of Medicine, Chicago, IL; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser, Los Angeles; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Division of Neurology (A.D.H.), Cincinnati Children's Hospital Medical Center, OH; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology, NeuroDevelopmental Science Center (M.C.V.), Akron Children's Hospital, OH; Rochester (E.M.G.), NY; St. Paul (E.L.), MN; O'Fallon (H.Z.), MO; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and Department of Neurology (K.M.), Mayo Clinic, Rochester, MN.
Abstract
OBJECTIVE: To provide evidence-based recommendations for the acute symptomatic treatment of children and adolescents with migraine. METHODS: We performed a systematic review of the literature and rated risk of bias of included studies according to the American Academy of Neurology classification of evidence criteria. A multidisciplinary panel developed practice recommendations, integrating findings from the systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS: There is evidence to support the efficacy of the use of ibuprofen, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents. There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache-free at 2 hours than those receiving placebo. No acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia. RECOMMENDATIONS: Recommendations for the treatment of acute migraine in children and adolescents focus on the importance of early treatment, choosing the route of administration best suited to the characteristics of the individual migraine attack, and providing counseling on lifestyle factors that can exacerbate migraine, including trigger avoidance and medication overuse.
OBJECTIVE: To provide evidence-based recommendations for the acute symptomatic treatment of children and adolescents with migraine. METHODS: We performed a systematic review of the literature and rated risk of bias of included studies according to the American Academy of Neurology classification of evidence criteria. A multidisciplinary panel developed practice recommendations, integrating findings from the systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence. RESULTS: There is evidence to support the efficacy of the use of ibuprofen, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents. There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache-free at 2 hours than those receiving placebo. No acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia. RECOMMENDATIONS: Recommendations for the treatment of acute migraine in children and adolescents focus on the importance of early treatment, choosing the route of administration best suited to the characteristics of the individual migraine attack, and providing counseling on lifestyle factors that can exacerbate migraine, including trigger avoidance and medication overuse.
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