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Endorsed papers shed light on migraine, perinatal palliative care :

October 28, 2019
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The AAP has endorsed a committee opinion on perinatal palliative care and two guidelines on preventing and treating migraines in children and teens.

Perinatal palliative care

A coordinated strategy on how to deliver perinatal palliative comfort care is the focus of a recent AAP-endorsed committee opinion from the American College of Obstetricians and Gynecologists.

Perinatal Palliative Care, at http://bit.ly/2liAqeu, offers recommendations to maximize quality of life and comfort in infants with life-limiting conditions when there is no intent to prolong life. It is one of several options that should be discussed with patients faced with pregnancies complicated by life-limiting fetal conditions. 

A multidisciplinary team is best to support the care and prepare families to handle differences of opinion that may arise among parents, providers and family members, according to the committee opinion.

Health care providers and institutions are encouraged to develop programs that may include a formal prenatal consultation, development of a birth plan, access to other neonatal and pediatric specialties as needed, and support and care during the prenatal, birth and postnatal periods. This includes bereavement counseling. Communication should be effective and compassionate and support the patient’s cultural beliefs and values.

Migraine prevention, treatment

Practice Guideline Update: Acute Treatment of Migraine in Children and Adolescents and Practice Guideline Update: Pharmacologic Treatment for Pediatric Migraine Prevention Study were developed by the American Academy of Neurology and the American Headache Society.

The guidelines, at http://AAN.com/guidelines, examine evidence on acute treatments to stop or lessen pain and other symptoms during an attack and treatments to prevent or reduce the frequency of migraine attacks and lower the impact of migraines on kids’ functioning at school, home and socially.

Evidence-based treatments are effective for treating migraine attacks in children and teens, but medications were comparable to placebo for preventing recurrent migraine attacks, according to the guidelines. Both medication and placebo were effective for more than half of the patients. There was little evidence to guide treatment of related symptoms like nausea and light sensitivity.

The guidelines offer the following points on caring for children and teens with migraine.

  • Patients should have a detailed history, examination and neurological examination, possibly from a neurologist or headache specialist.
  • Families should be counseled about factors associated with migraine, such as lack of physical activity, too much caffeine, not enough sleep and dehydration.
  • Co-occurring conditions such as depression or anxiety should be considered.
  • Cognitive behavioral therapy can be effective when used with medication.
  • Patients should be urged to treat migraine as soon as they are aware of an attack. Medications such as ibuprofen, triptans and combination sumatriptan/naproxen can help relieve pain during an attack.
  • Botulinum toxin does not help prevent migraine in children, despite its success in adults, according to the guidelines.

Guideline authors called for further study to determine whether newer treatments (e.g., calcitonin gene-related peptide antibodies) and devices are effective in children and teens.

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