Treatment of Primary Headaches in Paediatric Age: A Comprehensive Review

Primary headaches have a high prevalence in paediatric age and may pose a high strain on the quality of life of young patients. Adequate care involves a patient-by-patient approach, and this generally relies both on bio-behavioural measures and on pharmacological and non-pharmacological interventions. We performed an updated review on acute and preventive pharmacological treatments for juvenile primary headaches emphasizing the efficacy and tolerability of the various molecules. Our literature review emphasized that most of the available information on paediatric primary headaches is derived from relatively low quality data; therefore, results should be considered with caution, and quality data from future large series should be warranted. With these limitations, in general there is broad agreement in considering analgesics and NSAIDs as first-line pharmacological treatments in the acute phase both for migraine and TTH in children. As regards migraine, other medications used for attacks may include antiemetics and triptans, whereas calcium-channel blockers, antihypertensive drugs, serotonin modulators, antidepressants and antiepileptics may be used for prophylaxys. Data are more limited as regards prophylaxis of paediatric TTH, though amitriptyline and magnesium have been used in these cases. Non pharmacological interventions may also provide useful in both headache types, as well as alternative therapies, also in view of their more favourable tolerability profile, and these therapies should be conjugated with more traditional medications to maximise the patient’s benefit.