Migraine in Children: Barriers to Care

While neurologists are well aware that migraine in children can have a major impact on their school performance, family, and social lives, findings suggest that pediatric patients face barriers to appropriate care.

The American Migraine Foundation (AMF) has initiated public awareness campaigns aimed at improving access to care for pediatric migraine patients. “Too many children who see a doctor for migraine are not getting medication for their pain,” says Robert A. Nicholson, PhD, FAHS, Director of Behavioral Medicine at Mercy Clinic Headache Center/Mercy Health Research in St. Louis, and an American Migraine Foundation board member. “And too few are receiving care consistent with evidence-based guidelines.  For example, many are prescribed opiates as a first-line treatment, an approach that is not recommended by migraine treatment specialists.”

Stephen Silberstein, MD spoke with Practical Neurology™ about the latest migraine treatment guidelines for the March edition, available online at PracticalNeurology.com.

“Emotional and school performance problems are often issues for children with migraine. They can be as difficult for kids with migraine to manage as they are for those with other serious diseases or conditions,” says David W. Dodick, MD, FRCP (C), Chair of the AMF and Professor of Medicine at the Mayo Clinic College of Medicine in Scottsdale.

Dr. Dodick recommends that parents consider seeking advice from a migraine specialist to discuss treatment that may minimize the effect of exercise on migraine. Until then, he also recommends that parents support their child’s decision to opt out of sports or exercise until they find relief.  If their child does feel able to take part, however, parents should encourage them to do as much as they feel comfortable with, and to monitor if and when the impact of their activity may trigger a migraine attack.

“Young migraine sufferers endure the same obstacles to getting relief from their pain as older migraine sufferers, including not having their pain taken seriously,” Dr. Dodick says.  “Many myths and beliefs persist in our culture that make it difficult to get a proper diagnosis and treatment.”

Neurologists treating pediatric migraine patients may consider directing patients and their families to resources offered by the AMF through its website, www.americanmigrainefoundation.org. Working with Phoenix Children’s Hospital pediatric neurologist/headache specialist Marcy E. Yonker, MD, the American Migraine Foundation developed a range of resources and information on migraine in children. The site’s current “Spotlight on Migraine in Children” is a feature packed with information for parents and children themselves on recognizing and better managing migraine. Current Spotlight articles include “Helping Your Child Manage Migraine”; “What Triggers Migraine Attacks in Children”; “What Symptoms Should I Look for in My Kids?”; “Migraine Hurts Children’s School, Family and Social Lives”; and “Pediatric Migraine: A Primer for Teachers and School Nurses.” n