propranolol, tricyclic antidepressants, cyproheptadine (Periactin), VPA, and calcium channel blockers More recent studies of antiepileptic medications have shown some efficacy in preventing migraine headaches in adult patients, including gabapentin, topiramate, lamotrigine, and tiagabine Clinical Indications for Discharge/Admission Most patients with migraine can be successfully managed as outpatients Admission is reserved for those in whom continued parenteral therapy is needed to control symptoms Patients with chronic or recurrent symptoms requiring prophylactic treatment should be referred to a neurologist Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) Goals of Treatment In addition to pain relief, initial treatment in idiopathic intracranial hypertension (IIH) is directed at preventing neurologic sequelae CLINICAL PEARLS AND PITFALLS Many children with intracranial hypertension have an identifiable cause While papilledema is very commonly seen, some children may present without papilledema Current Evidence IIH, also called pseudotumor cerebri syndrome, is a poorly understood condition of increased ICP It may occur at any age during childhood but is more common in adolescents, especially in obese individuals Females are more commonly affected A number of other conditions have been reported in association with IIH; these include anatomic anomalies (cerebral venous abnormalities), infections (otitis media, mastoiditis, Lyme disease), endocrinologic conditions (hyperthyroidism, Addison disease), medications (steroid withdrawal, oral contraceptives, tetracycline, hypervitaminosis A), and mild head trauma However, a causal relationship remains unproved, and in most cases of IIH, no cause is identified The mechanism of increased ICP in IIH remains unknown, although several hypotheses have been postulated, including vasogenic brain edema and impaired reabsorption of cerebrospinal fluid (CSF) by the arachnoid villi Clinical Considerations