Maternal High-Dose Vitamin D Supplementation and Offspring Bone Mineralization Until Age 6 Years

Abstract

In Reply I greatly appreciate the comments from Gelfand and Goadsby. For many years they have striven to lessen the pain of children with chronic headaches. Their letter in response to my Editorial 1 on the excellent article from Locher et al 2 provides me with the opportunity to differentiate my biopsychosocial perspective on migraine. 1. Children with migraine benefit from a multimodal approach. For example, the Editorial from Gelfand et al 3 on the Childhood and Adolescent Migraine Prevention (CHAMP) study, 4 a negative clinical trial on prophylactic treatment in pediatric migraine, states "Every month, CHAMP study participants received education regarding the importance that regular sleep, exercise, meals, and hydration play in managing migraine frequency. This advice, and the frequency and repetition with which it was offered, may have been quite beneficial. Participants were also given evidencebased acute migraine treatment-specifically nonsteroidal anti-inflammatory drugs and triptans-at optimal dosing along with instructions on how to avoid medication overuse. This may have had a role in helping them control their migraine frequency." 3,4 What they describe here as being beneficial is a good example of a modular approach, including psychological (education) and biological (attack medication) treatment. The efficacy of psychological interventions in migraine, including pain neuroscience education and cognitive behavioral therapies, is well proven. According to the latest Cochrane review on pediatric headache, 5 the number needed to treat to reduce headache frequency is 2.9. 5 To consider psychosocial dimensions in migraine does not blame the patient for being responsible for a condition with a clear genetic predisposition. However, it helps to increase self-efficacy, empowers children with migraine, and improves outcomes. 2. For many pediatric patients, migraine is a lifelong companion. They have to learn to cope with it and to live a happy, active life despite migraine. A short period of pharmacologic prophylactic treatment is not an appropriate answer to a challenge of having migraine for decades. Furthermore, prophylactic drugs may be responsible for severe adverse events. In the CHAMP study, 30% of children taking amitriptyline had fatigue and 31% of children receiving topiramate experienced paresthesia. 4 These adverse effects reduce quality of life as much as the migraine itself, perhaps even more. In some cases, those prophylactic drugs even cause death, whether intentionally in suicide or by accident by the patient or other family members. 3. There is a huge, billion-dollar market on pharmacologic prophylactic treatment for migraine. One has to be aware of the potential effect pharmaceutical companies might have on our point of view, the ideas we develop on the definition, and classification of diseases and on our research questions. 6 Psychosocial factors are often associated with higher migraine frequency. Botulinum toxin injections or CGRP antibodies are not the appropriate tool to address co...