Headaches and migraines are a common neurologic condition amongst pediatric population, and can be debilitating and even disabling for many of our young patients. While amitriptyline and/or topiramate were at one point considered the first-line therapy modalities by physicians, a recent multi-center clinical trial (CHAMP) revealed no significance in these modalities over placebo, while still maintaining concerns related to documented side effects. However, cognitive behavioral therapy (CBT) remains among the treatment of choice and the recommended first line treatment for migraines in adolescents. Accordingly, based on the review of the literature, the authors propose a pediatric migraine management workflow in a multidisciplinary care network model, involving child neurology, primary care, pediatrics, family medicine, and child psychology. As clinical psychology utilization continues to be fostered more and more in primary care, it is imperative that evidence-based treatment modalities such as CBT are effectively and efficiently utilized in an ever-evolving healthcare landscape.
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