By vgreene, 31 December, 2019 If migraine control established: Counsel re risk/benefits of stopping meds1 Consider tapered withdrawal after 6mo to
By vgreene, 31 December, 2019 If preventive med started: Periodically monitor effectiveness and adverse events2
By vgreene, 31 December, 2019 Counsel pts of childbearing potential re risks of meds such as topiramate2 and valproate2
By vgreene, 31 December, 2019 Counsel families that majority of meds not superior to placebo in ped trials;2 incl meds recommended for migraine prevention in adults3
By vgreene, 31 December, 2019 If med-overuse HA (may coexist w/ chronic migraine):2 Stop overused med2,3 and start 1st-line prevention tx, per AAN/AHS1
By vgreene, 31 December, 2019 If not responsive to 1st drug trial: Consider 2+ mo trial w/ different 1st-line agent, per AAN/AHS
By vgreene, 31 December, 2019 Offer 1st-line tx: topiramate,1 propranolol, or combo amitriptyline1,4 + CBT; minimum med trial 2+ mo;1 factor comorbidities (eg, topiramate,1 an appetite suppressant, if obese), per AAN/AHS.1 CBT benefits sx mgmt support, per EHF2
By vgreene, 31 December, 2019 Don’t use opioids: No evidence supports opioid use in pedi migraine1,2