Headaches are common in a busy pediatric neurology office. Most pediatric headaches can be managed by addressing lifestyle contributions and everyday stressors. New medications are on the horizon, particularly gepants, which are effective in managing refractory migraines. Headache Care by Pavitt et al. in the March issue of Pediatrics in Review provides a review on differentiating primary versus secondary headaches and identifies red flags that would prompt a referral to a pediatric neurologist.
The article outlines acute and preventive strategies for managing pediatric headache disorders. As a pediatric neurologist in a busy academic practice, addressing lifestyle contributions commonly negates the need to start pharmacological therapy. Pediatricians should develop a therapeutic alliance with the patient and their family.
Children and teenagers commonly deal with peer pressure, parental expectations, and cyberbullying. Building a therapeutic relationship with them is the most integral part of any practice. It’s important to discuss their migraine triggers during each visit and develop an individualized plan, emphasizing the importance of decreasing screen time and maintaining good sleep hygiene, healthy eating, and regular exercise. It can be helpful to start daily nutraceuticals, like riboflavin, and implement behavioral interventions like biofeedback and cognitive behavioral therapy. Addressing hydration and rest before taking abortive medications can avoid the risk of medication-overuse headaches.
The SMART (Sleep, Meals, Activity, Relaxation, Trigger) recommendations for migraine care, outlined in this article, provide an optimal framework for managing lifestyle changes for regulating migraine care. For example, because obesity is linked to increased migraine frequency, developing a personalized plan of healthy eating habits and regular exercise to prevent and manage obesity can be an essential part of an individual plan, in addition to addressing the stigmatism of obesity and its root causes.
The most rewarding part of practicing pediatrics is often building a therapeutic alliance with the patient and their family, and it is often the key to headache care that goes beyond—or before—medications.
