Jack Gladstein, MD

I read with keen interest Dr Jack Gladstein's article, "Pediatric Migraine: Strategies for Maintaining Control," in the August issue of CONSULTANT FOR PEDIATRICIANS (page 316). It prompted several follow-up questions, which I hope the author can respond to.

The management of pediatricmigraine incorporates lifestyle strategieswith acute therapy and preventivemeasures. Lifestyle changes that candiminish the frequency and intensity ofmigraines include maintaining regularsleeping, eating, and exercise habits;staying well hydrated; dealing withstress; and avoiding dietary triggers ofmigraine. Acute treatment represents arace against the clock: the longer aheadache continues to smolder, the harderit is to treat. An over-the-counteragent may help in the very early stagesof headache: if it does not, however,it must be followed within an hour by atriptan. Patients with significantmigraine disability may need preventionmedications or alternative therapies.

In most children, migraine manifests with severe bilateral pain, nausea and/ or vomiting, and photophobia or phonophobia.