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    Kids' Migraines: Over-the-Counter Drugs Best

    New Pediatric Migraine Guidelines Wary of Newer Drugs

    Good News: Nondrug Treatment Works continued...

    "The happy news is that the outcomes for behavioral migraine treatments are really quite strong," Penzien tells WebMD. "They not only treat pain but have the added bonus of helping with the family and school disruption that goes with headache."

    The key to behavioral treatments for migraine is a healthy lifestyle, Lewis says.

    "Teens, for example, often have chaotic sleep patterns. They tend to skip breakfast, get too much caffeine either in sodas or lattes, and often experience a lot of stressors in their lives," he says. "So we make sure they eat right and get exercise -- that is critical. I mandate 20-30 minutes of exercise every single day. We do a lifestyle change, keep a migraine calendar, and then we can see whether further treatment is needed."

    Lewis and Penzien agree that no single approach works for every child. But many approaches that work for adults can easily be adapted for children.

    "The same treatments for adults that we call behavioral -- relaxation, biofeedback, stress management, cognitive-behavioral psychotherapy -- with special adaptations can be made for children," Penzien says. "The self-regulation training therapies - the relaxation, the biofeedback -- tend to work much better for kids. They take to it like a duck to water."

    When Drugs Are Needed

    Despite behavioral therapy, children may still have migraines from time to time. When they do, drugs can help.

    "If in spite of lifestyle modification a child is having one or two disabling headaches a month, we try to treat them," Lewis says.

    Penzien says headache specialists are wary of as-yet-unknown long-term effects of migraine drugs on children.

    "We tend to treat conservatively with the medications -- not because we are anti-medication, but because the potential for side effects are strong with developing nervous systems," Penzien says. "Even though we don't know there is a problem with the newer drugs, it makes you nervous. The truth is that most children are using a combination of drugs and behavioral therapy. Usually the safer analgesics over the counter can be quite helpful."

    The biggest problem facing children with migraines is not that there are few proven treatments. The problem, Lewis says, is that parents and doctors are slow to recognize serious headaches in children.

    "The first step is to get it recognized that a child suffers from migraine headaches," Lewis says. "There is a gross under-recognition of the problem in children. Many parents don't know that children can have migraines. Yet up to 5% of elementary school children and 15% of high school children do."

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