Pediatric Migraine Presentation and Treatment Algorithm

Children are not young adults; thus, we have to take a different approach with caring for this population. Children may have similar pathophysiology as adults but respond differently to psychosocial variants and may have some clinical variants that are not present in adults. For example, pain itself is a subjective feeling that is objectively measured with specific pain scales, but this can be challenging to assess in younger children who have difficulties expressing symptoms they are experiencing. Standard pain-related questions may not capture the full picture, as children may have a difference in perception of pain. It is important to note that most of the information collected may be primarily provided by parents/guardians. When taking the history, it is more advantageous to direct specific questions to the child at a level he/she understands. The primary goal is to gather relatively good history and description of the symptoms using clues, even drawings (this has shown to be a very sensitive tool in younger children). It is the only way to discover what the child is feeling without having the clinical symptoms translated through an interpreter (the parents/guardians), for example, a little boy goes into a dark room and stops playing (photophobia) or a 5-year-old girl drawing herself with a hammer hitting her head (throbbing). This chapter will review key differences in childhood primary headache presentations and summarize different strategies used in treating those headaches including acute, preventive, and behavioral therapies.