An 8-month, double-blind, placebo-controlled crossover trial was carried out on the use of nimodipine in migraine prophylaxis in 37 patients aged 7 to 18 years old. After a 4-week medication-free run-in period, 19 subjects (Group 1) received a placebo while 18 (Group 2) received nimodipine (10-20 mg t.i.d., according to body weight), for 12 weeks. After a 4-week wash-out period, the groups switched therapy for a further 12 weeks. 30 patients completed the trial and the number of dropouts was comparable in the 2 groups. The only side-effect during nimodipine treatment was mild abdominal discomfort (3 cases). The treatments were evaluated on the basis of frequency and duration of attacks. There was a significant reduction in both parameters during the first period of treatment. During the second period of treatment, nimodipine proved to have a significantly greater effect than the placebo with regard to frequency, whereas the response was similar with the placebo as regards duration of attacks. The latter parameter shows a significant decrease during the treatment periods, regardless of type of therapy.

An 8-month, double-blind, placebo-controlled cross-over trial was carried out on the use of trazodone in pediatric migraine prophylaxis. It involved 40 patients aged 7 to 18 years old and suffering from migraine without aura, randomly divided into 2 groups. After a 4-week run-in period, Group A received oral trazodone (1 mg/kg a day divided into 3 doses) for 12 weeks, while Group B received a placebo. After a further 4-week washout period, Group A was given the placebo and Group B was treated with trazodone for a further 12 weeks. The trial was completed by 35 patients, the number of drop-outs being comparable in the two groups. During the first treatment period, both the frequency and the duration of the migraine episodes were significantly reduced in both groups. During the second, a significant further improvement in both parameters was only observed in Group B. No side-effects were observed at any time. Our results showed that, like other antidepressants, trazodone is a valid prophylactic agent for juvenile migraine.

Electronic pupillometry before and after phenylephrine eye drops was performed in 83 headache patients divided into two groups: Group A included 59 pediatric patients aged 5 to 16 years suffering from tension headache (TH = 8), common migraine (CM = 33) and classic migraine (CLM = 18); Group B comprised 24 adult patients aged 28 to 49 years suffering from CM. Comparisons were made with a group of healthy volunteer controls, 12 children and 15 adults, not suffering from headache. In Group A, only the CLM patients had significant mydriasis after phenylephrine; pupillary responses in the TH and CM cases did not differ significantly from the healthy controls, although there was an evident tendency for increased response in the CM by comparison with the TH cases. On the other hand, in Group B (adult CM) there was a significant pupillary hyper-responsiveness to adrenergic receptor stimulation, higher than in the same clinical condition in the pediatric group. In pre-pharmacological testing conditions, a significantly higher percentage of anisocoria (p less than 0.05) and a significant reduction in mean pupil size (p less than 0.01) were only evident in adult migraineurs as compared with controls. These findings suggest that a subtle chronic sympathetic deficiency affecting the iris neuromuscular junction in some clinical forms of primary headache may be detected by pupillometry at an early age. Moreover, apart from a temporal factor responsible for a progressive sympathetic imbalance during development, there may be a more evident neural transmission disorder in migraine forms as opposed to tension forms.

99mTC HM-PAO SPECT brain imaging was performed during the headache-free period in 19 young migraineurs, affected by common migraine (CM, 10 cases), classic migraine (CLM, 6 cases) and hemiplegic migraine (HM, 3 cases). SPECT findings were negative in all 10 patients with CM, in 3 cases of CLM and in 2 cases of HM. Positive findings in the remaining 4 patients (3 cases of CLM and 1 of HM) showed a decreased tracer distribution in the temporo-occipital regions (2 cases) and parietal regions (2 cases): the two with decreased temporo-occipital perfusion reported prodromal symptoms exclusively contralateral to the areas of hypoperfusion. An impaired regional cerebral vascular autoregulation may exist even during headache-free intervals in patients suffering from classic and hemiplegic migraine.

Electronic pupillometry before and after phenylephrine instillation in the right eye was carried out in 18 children aged 10 to 16 years suffering from recurrent abdominal pain (RAP) and 15 age-matched controls. Before stimulation the pupillary diameter was almost equal in the two groups. After phenylephrine eye drops iris dilatation was greater in RAP patients than in controls, even though the difference was not statistically significant. These results seem to suggest children with RAP have a chronically disturbed receptor sensitivity in their iris neuromuscular junction caused by a sympathetic hypofunction, similar to that already reported in migrainous patients.