Treating acute headache in children
There is a lack of evidence on which to base the treatment of acute headache in children, according to specialists in the US and Canada, but ibuprofen has a primary role.

Little is known about how best to manage headache in children presenting at a hospital emergency department, say investigators in Washington.(1) Most published studies involve children with migraine and have evaluated the triptans, while none has trialled treatments for tension headache. Most authors endorse an initial trial of ibuprofen for children over 12 years of age followed by intranasal sumatriptan for persistent migraine symptoms. When nausea or vomiting are prominent, antiemetics offer a further option.

Montreal investigators reviewed randomised clinical trials of potential emergency treatments for acute migraine but found only one carried out in a hospital emergency department in children whose pain persisted after initial therapy.(2) This showed that prochlorperazine was more effective than the NSAID at relieving pain after one hour. Other trials have evaluated initial treatments in outpatient settings (representing a patient population with acute but not refractory pain). These studies demonstrated the efficacy of ibuprofen and paracetamol but cast doubt on the value of oral sumatriptan or dihydroergotamine; evidence for other triptans was inconclusive.





References

1. Walker DM, Teach SJ. Emergency department treatment of primary headaches in children and adolescents. Curr Opin Pediatr 2008;20:248-54

2. Bailey B, McManus BC. Treatment of children with migraine in the emergency department: a qualitative systematic review. Pediatr Emerg Care 2008;24:321-30

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