Paediatric migraine: evidence-based management and future directions

Abstract

Migraine is prevalent in children and adolescents and constitutes an important cause of disability in this population. Early, effective treatment of paediatric migraine is likely to result in improved outcomes. Findings from the past few years suggest that a biopsychosocial approach that uses interdisciplinary multimodal care is most effective for treatment of migraine in the paediatric population. Key elements of this management include effective and timely acute pharmacological interventions (such as NSAIDs and/or triptans), education of patients regarding self-management techniques, and psychological interventions such as biofeedback, relaxation and cognitive-behavioural therapy. The efficacy of current pharmacological or nutraceutical interventions for migraine prevention in children and adolescents is unclear, although reported placebo response patterns suggest that the effect of pill-taking behaviour is positive. As such, clinicians can consider adding a preventive intervention that involves a daily pill-taking behaviour to evidence-based non-pharmacological first-line preventive interventions (such as cognitive-behavioural therapy). More rigorous research is needed to delineate the role of pharmacological and nutraceutical interventions, the mechanisms of the clinically relevant placebo response, and interventions that enhance this response for migraine prevention in this population. Given the prevalence of migraine, cost-effective and efficacious strategies are needed for the large-scale delivery of interdisciplinary multimodal paediatric migraine care.

Alterations in Brain Function After Cognitive Behavioral Therapy for Migraine in Children and Adolescents

“…A previous study from our group (which used the same CBT manual as the present study and in the same clinic population of pediatric migraine patients) showed a greater reduction in headache frequency in the CBT + amitriptyline group compared to the control education + amitriptyline group 36 . Of particular note, the improvements that result from CBT reach a high level of clinical significance, and similar levels of improvements were seen in the current study 36,59,60 . Thus, we feel it is highly probable that the headache reduction and consequential changes in brain activation and connectivity are due to CBT‐specific effects rather than the passage of time 35 .…”

Tolerability of Palmitoylethanolamide in a Pediatric Population Suffering from Migraine: A Pilot Study

“…e treatment of migraine in pediatric age encounters numerous obstacles considering that traditional medicines do not have the same evidence of efficacy as in adults, and the new drugs against CGRP have not been systematically tested in this age group. Furthermore, the high response to placebo raises doubt about the actual need to treat migraine children with drugs that may have adverse effects [20]. is is why the choice falls very often on nutraceuticals whose efficacy data however remain conflicting [8].…”

The influence of allergic rhinoconjunctivitis on migraine disability in children

“…The treatment of migraine in childhood does not have a high quality of evidence 24 , a fact that justifies the search for new perspectives on managing this troubling and sometimes disabling condition. In this setting, investigating the ways of controlling a comorbid trigger of migraine is desirable.…”