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2. Non-pharmacologic measures in the management of pediatric and adolescent

migraine promote general well-being and good health. They can improve the

overall quality of life. These measures are basically three:

• Lifestyle

• Therapies – physical therapy, yoga, stress management, relaxation

techniques, breathing exercises, visualization, biofeedback and cognitive

behavioral therapy

• Exercise

3. People who use acute pain medicine for headaches more than two or

three times a week or more than 10 days out of the month may develop

‘medication overuse headaches’ (MOH). This important phenomenon should

be part of management discussion.

4. The classroom environment can be challenging for children with ADHD. The

treating pediatrician, parent, and child, in collaboration with school personnel

(teacher and educational psychologists), should specify appropriate target

outcomes to guide management. Primary care physicians / pediatricians

cannot work alone in the treatment of school-aged children with ADHD.

Ongoing communication with parents, teachers, and other school-based

professionals is necessary to monitor the progress and effectiveness

of specific interventions. This will go a long way in making a significant

difference in their academic and overall school experience.

5. Children with ADHD should best be treated with a multimodal approach,

using a combination of strategies. This will include:

• Psychoeducation (both children and parents)

• School accommodations (should be made in consultation with teachers

and school psychologists)

• Family therapy, support, respite for parents

• Parenting strategies

• Healthy lifestyle (sleep hygiene, age appropriate physical activity, healthy

eating, emphasis on screen time and mindfulness)

• Medications

• Alternative therapies.

6. Sleep and screen time are important lifestyle determinant. There should be

more emphasis on these two important measures, especially in children with

ADHD. Resources in this regard:

https://sleepfoundation.org/

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https://sleepfoundation.org/how-sleep-

works/how-much-sleep-do-we-really-need

http://www.nrcresearchpress.com/doi/abs/10.1139/apnm-2016-0100