Pharmacologic Treatment of Pediatric Headaches

El‐Chammas, Khalil; Keyes, Jill; Thompson, Nathan E.; Vijayakumar, Jayanthi; Becher, Dorothy; Jackson, Jeffrey L.

doi:10.1001/jamapediatrics.2013.508

Cited by 93 publications

(70 citation statements)

References 55 publications

(32 reference statements)

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“…Although amitriptyline is the most common preventative medication for headaches worldwide, 11 and is recommended by national practice parameters and open-label studies, 12,14 its effectiveness compared with placebo in youth remains unknown. 8,33,36 Using amitriptyline as a constant in this study allowed for a clear comparison of CBT with headache education.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Behavioral Therapy Plus Amitriptyline for Chronic Migraine in Children and Adolescents

Powers

Kashikar‐Zuck

Allen

et al. 2013

JAMA

239

271

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IMPORTANCE Early, safe, effective, and durable evidence-based interventions for children and adolescents with chronic migraine do not exist.OBJECTIVE To determine the benefits of cognitive behavioral therapy (CBT) when combined with amitriptyline vs headache education plus amitriptyline. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial of 135 youth (79% female) aged 10 to 17 years diagnosed with chronic migraine (Ն15 days with headache/month) and a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points were assigned to the CBT plus amitriptyline group (n = 64) or the headache education plus amitriptyline group (n = 71). The study was conducted in the Headache Center at Cincinnati Children's Hospital between October 2006 and September 2012; 129 completed 20-week follow-up and 124 completed 12-month follow-up.INTERVENTIONS Ten CBT vs 10 headache education sessions involving equivalent time and therapist attention. Each group received 1 mg/kg/d of amitriptyline and a 20-week end point visit. In addition, follow-up visits were conducted at 3, 6, 9, and 12 months. MAIN OUTCOMES AND MEASURESThe primary end point was days with headache and the secondary end point was PedMIDAS (disability score range: 0-240 points; 0-10 for little to none, 11-30 for mild, 31-50 for moderate, >50 for severe); both end points were determined at 20 weeks. Durability was examined over the 12-month follow-up period. Clinical significance was measured by a 50% or greater reduction in days with headache and a disability score in the mild to none range (<20 points).RESULTS At baseline, there were a mean (SD) of 21 (5) days with headache per 28 days and the mean (SD) PedMIDAS was 68 (32) points. At the 20-week end point, days with headache were reduced by 11.5 for the CBT plus amitriptyline group vs 6.8 for the headache education plus amitriptyline group (difference, 4.7 [95% CI, 1.7-7.7] days; P = .002). The PedMIDAS decreased by 52.7 points for the CBT group vs 38.6 points for the headache education group (difference, 14.1 [95% CI, 3.3-24.9] points; P = .01). In the CBT group, 66% had a 50% or greater reduction in headache days vs 36% in the headache education group (odds ratio, 3.5 [95% CI, 1.7-7.2]; P < .001). At 12-month follow-up, 86% of the CBT group had a 50% or greater reduction in headache days vs 69% of the headache education group; 88% of the CBT group had a PedMIDAS of less than 20 points vs 76% of the headache education group. Measured treatment credibility and integrity was high for both groups.CONCLUSIONS AND RELEVANCE Among young persons with chronic migraine, the use of CBT plus amitriptyline resulted in greater reductions in days with headache and migraine-related disability compared with use of headache education plus amitriptyline. These findings support the efficacy of CBT in the treatment of chronic migraine in children and adolescents.

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Section: Discussionmentioning

confidence: 99%

Cognitive Behavioral Therapy Plus Amitriptyline for Chronic Migraine in Children and Adolescents

Powers

Kashikar‐Zuck

Allen

et al. 2013

JAMA

239

271

View full text Add to dashboard Cite

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“…Expert advice is recommended for other medications because data are limited (cyproheptadine, propranolol, flunarazine, sodium valproate, dihydroergotamine) or absent (amitriptyline, topiramate) regarding use for abdominal migraine. It is unknown whether evidence on acute76 or preventive management88 of childhood migraine headache can be extrapolated to abdominal migraine. The only evidence for treatment of adult abdominal migraine is from case reports 68…”

Section: How Are Children With Abdominal Migraine Managed?mentioning

confidence: 99%

Abdominal migraine

Angus‐Leppan

Sutcliffe

Guiloff

2018

BMJ

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“…Topiramate is very effective in decreasing headaches. Pediatric efficacy can be seen in a meta-analysis of topiramate and trazodone [15]. Administration of 50 mg topiramate at night can be helpful for headache reduction.…”

Section: Treatmentmentioning

confidence: 99%

Pediatric Headaches

Slover

Kent

2015

Advances in Pediatrics

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Pediatric headaches are common, and many may never require intervention by a health care provider. However, migraines can become more difficult to treat, especially if they become chronic daily headaches. Pediatric headache is a subjective and unique experience that requires attention to both psychological and physiologic components in diagnosis and treatment. A biopsychosocial, multidisciplinary approach, including both medication management and psychological treatment, is considered essential for effective management.

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Pharmacologic Treatment of Pediatric Headaches

Cited by 93 publications

References 55 publications

Cognitive Behavioral Therapy Plus Amitriptyline for Chronic Migraine in Children and Adolescents

Cognitive Behavioral Therapy Plus Amitriptyline for Chronic Migraine in Children and Adolescents

Abdominal migraine

Pediatric Headaches

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