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IV fluids
0%
0/12
Acetaminophen
Ibuprofen
42%
5/12
Sumatriptan
50%
6/12
Morphine
Select Answer to see Preferred Response
A girl with a multi-hour long throbbing frontal headache associated with nausea, vomiting, and photophobia most likely has a migraine. Acetaminophen and NSAIDS are the first line treatment for migraines in children and adolescents. Since acetaminophen has already been tried, ibuprofen should be used next. Treatment for migraine in children and adolescents is not well studied. However, the American Academy of Neurology recommends both acetaminophen and NSAIDS for children aged 6 and older. Additionally, for adolescents aged 12 and older, nasal sumatriptan seems to be effective, despite a lack of FDA approval. Insufficient evidence exists to recommend other triptans. Notably, studies have found adverse effects to be more common with sumatriptan than with NSAIDS or acetaminophen, making them preferred. Lewis reviews headaches in children and adolescents. Identifying the pattern of the headache is important as is a thorough physical exam, with careful attention to the neurological exam. Notably, imagining is only indicated if neurological abnormalities are identified or if the condition progresses. Silver et al. conducted a meta-analysis of randomized controlled trials of migraine treatment in children. Ibuprofen and sumatriptan were both found to have significant relative efficacy in comparison to placebo. Acetaminophen, zolmitriptan, rizatriptan, and dihydroergotamine did not. The authors recommend ibuprofen treatment prior to sumatriptan due to "lower cost and ease of access." Illustration A depicts a scotoma, a type of visual aura experienced in some migraineurs. Aura is a visual, sensory, or physicial neurological phenomenon experienced transiently (usually for 60 minutes or less) prior to the onset of the headache. Incorrect answers: Answer 1: Although hydration might help some, she has signs and symptoms of a migraine headache, which calls for more aggressive treatment than fluids. Answer 2: Since her mother already tried acetaminophen with no relief, a different medication should be tried. Studies show NSAIDS are more effective than acetaminophen in the treatment of migraines in children. Answer 4: Triptans should only be used in children if acetaminophen and NSAIDS do no work. Very little data on them exists in children, and they are not FDA approved for use in children. Answer 5: Morphine is not an appropriate treatment for a new-onset migraine headache.
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