Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea
Copyright © 2022 Yeungnam University College of Medicine, Yeungnam University Institute of Medical Science
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of interest
No potential conflict of interest relevant to this article was reported.
Funding
This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (NRF-2019R1F1A106336713).
Diagnostic criteria |
---|
Migraine without aura |
A. At least five attacks fulfilling criteria B–D |
B. Headache attacks lasting 4 to 72 hours (untreated or unsuccessfully treated)a) |
C. Headache has at least two of the following four characteristics: unilateral location, b)pulsating quality, moderate or severe pain intensity, aggravation by or causing avoidance of routine physical activity |
D. During headache, at least one of the following: nausea and/or vomiting, photophobia and phonophobia |
E. Not better accounted for by another ICHD-III diagnosis |
Migraine with aura |
A. At least two attacks fulfilling criteria B and C |
B. One or more of the following fully reversible six aura symptoms: visual, sensory, speech and/or language, motor, brainstem, retinal |
C. At least two of the following four characteristics: |
1. At least one aura symptom spreads gradually over 5 minutes, and/or two or more symptoms occur in succession |
2. Each individual aura symptom lasts 5–60 minutes |
3. At least one aura symptom is unilateral |
4. The aura is accompanied, or followed within 60 minutes, by headache |
D. Not better accounted for by another ICHD-III diagnosis, and TIA has been excluded |
ICHD-III beta, International Classification of Headache Disorders, 3rd edition beta version; TIA, transient ischemic attack.
a)Attacks may last 2 to 72 hours.
b)More often bilateral in children.
Reprinted from Lee [3] according to the Creative Commons License.
Reprinted from Lee [3] according to the Creative Commons License.
Adapted from Manoyana et al. [24] according to the Creative Commons License.
Drug | Usual dosage | Maximum per day |
---|---|---|
Acetaminophen (syrup/tablet) | 10–12.5 mg/kg every 4–6 hr | 75 mg/kg |
Age >13 yr: 650 mg every 6 hr | 4,000 mg | |
Ibuprofen (syrup/tablet) | 10 mg/kg every 6–8 hr | 30 mg/kg |
Age >12 yr: 200–600 mg every 6 hr | 2,400 mg | |
Naproxen sodium (tablet) | 5–7 mg/kg every 8–12 hr | |
Age >13 yr: 250 mg every 8 hr | 1,250 mg | |
Diclofenac (tablet/injection) | Per oral: 0.3–1 mg/kg every 8 hr | 150 mg |
IV, IM: 0.3–1 mg/kg every 12 hr | 150 mg | |
Ketorolaca) (injection) | IV: 0.5 mg/kg | 15 mg |
Age >15 yr: 10 mg | 60 mg | |
Prochlorperazine (tablet) | Age >5 yr: 0.25 mg/kg every 8 hr | 10 mg |
Age >12 yr: 5–10 mg every 8 hr | 30 mg | |
Domperidone (solution/tablet) | Age >12 yr: 0.25 mg/kg every 8 hr | 30 mg |
10 mg every 8 hr | ||
Almotriptan (tablet) | Age >12 yr: 6.25–12.5 mg | 25 mg |
Sumatriptan/naproxen (tablet) | Age >12 yr: 10 mg/60 mg | 85 mg/500 mg |
Adapted from Im and Cho [38] according to the Creative Commons License.
Diagnostic criteria |
---|
Migraine without aura |
A. At least five attacks fulfilling criteria B–D |
B. Headache attacks lasting 4 to 72 hours (untreated or unsuccessfully treated) |
C. Headache has at least two of the following four characteristics: unilateral location, |
D. During headache, at least one of the following: nausea and/or vomiting, photophobia and phonophobia |
E. Not better accounted for by another ICHD-III diagnosis |
Migraine with aura |
A. At least two attacks fulfilling criteria B and C |
B. One or more of the following fully reversible six aura symptoms: visual, sensory, speech and/or language, motor, brainstem, retinal |
C. At least two of the following four characteristics: |
1. At least one aura symptom spreads gradually over 5 minutes, and/or two or more symptoms occur in succession |
2. Each individual aura symptom lasts 5–60 minutes |
3. At least one aura symptom is unilateral |
4. The aura is accompanied, or followed within 60 minutes, by headache |
D. Not better accounted for by another ICHD-III diagnosis, and TIA has been excluded |
A. At least five headache attacks fulfilling the criteria from B to D |
B. The headache lasts for 30 minutes or longer (untreated or treated) |
C. The headache has at least one of the following characteristics: |
1. Pain of at least moderate severity |
2. Unilateral or bilateral headache |
3. Throbbing or pounding nature of pain |
4. Exertion intolerance; avoidance of walking or playing |
D. The headache is associated with at least one of the following: |
1. Loss of appetite, stomach discomfort, or dizziness |
2. Sensitivity to light and sounds as indicated by inability to watch TV or play on the computer or on electronic games |
3. Having one cranial autonomic symptom associated with headache attacks |
Not better accounted for by other diagnoses |
Headache red flag |
---|
Acute onset (<3 months) |
Severe vomiting |
High-risk underlying comorbidities |
Fever |
Focal motor abnormality |
Changes in mood or personality over days or weeks |
Altered conscious state |
Seizures |
Abnormal ocular movements, squint, pathological pupillary responses |
Increase in severity or characteristics of the headache |
Pain that wakes the child from sleep or occurs on waking |
Ataxia, gait abnormalities, impaired coordination |
Meningism |
Occipital headache |
Drug | Usual dosage | Maximum per day |
---|---|---|
Acetaminophen (syrup/tablet) | 10–12.5 mg/kg every 4–6 hr | 75 mg/kg |
Age >13 yr: 650 mg every 6 hr | 4,000 mg | |
Ibuprofen (syrup/tablet) | 10 mg/kg every 6–8 hr | 30 mg/kg |
Age >12 yr: 200–600 mg every 6 hr | 2,400 mg | |
Naproxen sodium (tablet) | 5–7 mg/kg every 8–12 hr | |
Age >13 yr: 250 mg every 8 hr | 1,250 mg | |
Diclofenac (tablet/injection) | Per oral: 0.3–1 mg/kg every 8 hr | 150 mg |
IV, IM: 0.3–1 mg/kg every 12 hr | 150 mg | |
Ketorolac |
IV: 0.5 mg/kg | 15 mg |
Age >15 yr: 10 mg | 60 mg | |
Prochlorperazine (tablet) | Age >5 yr: 0.25 mg/kg every 8 hr | 10 mg |
Age >12 yr: 5–10 mg every 8 hr | 30 mg | |
Domperidone (solution/tablet) | Age >12 yr: 0.25 mg/kg every 8 hr | 30 mg |
10 mg every 8 hr | ||
Almotriptan (tablet) | Age >12 yr: 6.25–12.5 mg | 25 mg |
Sumatriptan/naproxen (tablet) | Age >12 yr: 10 mg/60 mg | 85 mg/500 mg |
Level of evidence | Strength of recommendation | |
---|---|---|
Strong | Weak | |
High | Topiramate | Valproic acid |
Divalproex sodium | Flunarizine | |
Propranolol | ||
Metoprolol | ||
Moderate | Amitriptyline | Atenolol |
Nadolol | ||
Candesartan | ||
Low | Nebivolol | |
Cinnarizine | ||
Lisinopril | ||
Levetiracetam | ||
Zonisamide |
ICHD-III beta, International Classification of Headache Disorders, 3rd edition beta version; TIA, transient ischemic attack. Attacks may last 2 to 72 hours. More often bilateral in children. Reprinted from Lee [
Reprinted from Lee [
Adapted from Manoyana et al. [
IV, intravenous; IM, intramuscular. Ketorolac can be administered every 6 hours, but should not be used for more than 2 days.
Adapted from Im and Cho [