ReviewHeadache2026
Framework for headache management in pediatric patients with stroke and cerebrovascular lesions: A narrative review.
Review in Headache, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo present a practical, evidence-based framework for the management of headache disorders in pediatric patients with prior stroke or underlying cerebral vascular lesions, with particular attention to safety and efficacy of pharmacologic and non-pharmacologic therapies.
backgroundChronic headache is frequent after ischemic or hemorrhagic stroke (reported in 12-57% of patients) and is also common in cerebrovascular disorders. Pediatric patients with these conditions face unique therapeutic challenges because many typical headache medications have vasoactive or blood pressure-modulating effects that may increase cerebrovascular risk.
methodsWe performed a comprehensive MEDLINE literature review (July 2024) searching combinations of headache medication classes paired with specific neurovascular conditions. INCLUSION CRITERIA: English or translated articles since 1990, comprising human and animal in vitro/in vivo studies, narrative reviews, case series/reports. Extracted data were organized by vascular condition, with summary tables of preventive and acute interventions categorized by evidence of efficacy, safety, and theoretical risk.
resultsAcross conditions, vasoconstrictive agents (triptans, ergots) remain generally contraindicated or used with extreme caution in patients with vascular lesions due to risk of ischemia or hemorrhage. Anti-hypertensive agents (β-blockers, calcium channel blockers [CCBs], angiotensin II receptor blockers [ARBs]) are generally safe and may confer additional vascular benefit in post-stroke headache. Calcitonin gene-related peptide (CGRP) -targeting therapies are not formally contraindicated but may impair compensatory vasodilation in flow-dependent vascular lesions. Anti-seizure medications, antidepressants, melatonin, and non-pharmacologic therapies appear to have favorable risk-benefit profiles, although direct data in these populations are limited. Interventions addressing underlying vascular lesions (e.g., arteriovenous fistulas [AVF] embolization, arteriovenous malformations [AVM] or cavernoma resection, pial synangiosis) often lead to headache improvement.
conclusionIn pediatric patients with cerebrovascular disease who have headaches, individualized management is essential. Drug selection must incorporate vascular pathophysiology, hemodynamic stability, and collateral flow considerations. More prospective, pediatric-specific and lesion-specific studies are needed to guide optimal headache therapies in this complex population.
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