{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:49:46Z","timestamp":1791622186577,"version":"4.3.4"},"reference-count":193,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To present a practical, evidence\u2010based 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\u2010pharmacologic therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic headache is frequent after ischemic or hemorrhagic stroke (reported in 12\u201357% 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\u2013modulating effects that may increase cerebrovascular risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We 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\u00a0vitro\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 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\u2010hypertensive agents (\u03b2\u2010blockers, calcium channel blockers [CCBs], angiotensin II receptor blockers [ARBs]) are generally safe and may confer additional vascular benefit in post\u2010stroke headache. Calcitonin gene\u2010related peptide (CGRP) \u2010targeting therapies are not formally contraindicated but may impair compensatory vasodilation in flow\u2010dependent vascular lesions. Anti\u2010seizure medications, antidepressants, melatonin, and non\u2010pharmacologic therapies appear to have favorable risk\u2013benefit 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In 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\u2010specific and lesion\u2010specific studies are needed to guide optimal headache therapies in this complex population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.70159","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T07:11:36Z","timestamp":1786432296000},"page":"2138-2155","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Framework for headache management in pediatric patients with stroke and cerebrovascular lesions: A narrative review"],"prefix":"10.1111","volume":"66","author":[{"given":"Allison C.","family":"Hyland","sequence":"first","affiliation":[{"name":"Department of Neurology and Weill Institute for Neuroscience University of California San Francisco  San Francisco California USA"},{"name":"Department of Neurology, Division of Neurocritical Care Children's Hospital of Philadelphia, University of Pennsylvania  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