Predictors of Triptan Response in Pediatric Migraine

Johnson, Hannah; Goadsby, Peter J.; Gelfand, Amy A.

doi:10.1016/j.pediatrneurol.2016.01.022

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…5 The majority of current migraine acute treatments for adolescents are pharmacological. 6 These treatments may not always be effective, 7 they can cause side effects, and their overuse may lead to medication overuse headache 8,9 and migraine chronification. 10 Thus, there is a great unmet need for alternative acute migraine treatments that are both effective and well tolerated to improve the health and quality of life of adolescents with migraines.…”

Section: Introductionmentioning

confidence: 99%

Remote electrical neuromodulation for acute treatment of migraine in adolescents

Hershey

Lin²,

Gruper³

et al. 2020

Headache

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Objectives: Migraine is a common disabling neurological disorder. Current acute treatments for migraine in adolescents are mostly pharmacological and may have limited effectiveness, can cause side effects, and may lead to medication overuse. There is an unmet need for effective and well-tolerated treatments. Remote electrical neuromodulation (REN) is a novel acute treatment of migraine that stimulates upper arm peripheral nerves to induce conditioned pain modulation (CPM)-an endogenous analgesic mechanism. The REN device (Nerivio ® , Theranica Bio-Electronics Ltd., Israel) is a FDA-authorized device for acute treatment of migraine in adults. This study assessed the efficacy and safety of REN in adolescents with migraine. Design and Methods: This was an open-label, single-arm, multicenter study in adolescents (ages 12-17 years) with migraine. Participants underwent a 4-week run-in phase. Eligible participants continued to an 8-week treatment phase with the device. Pain severity, associated symptoms, and functional disability were recorded at treatment initiation, and 2 and 24 hours post-treatment. The primary endpoints of this study were related to the safety and tolerability of REN. The secondary endpoints were related to device efficacy and included the proportion of participants who achieved pain relief at 2 hours post-treatment and the proportion of participants who achieved pain freedom at 2 hours. The presented results reflect an interim analysis with subsequent stopping of the rest of the study. Results: Sixty participants were enrolled for the study; of these, 14 failed to meet the run-in criteria and 1 was lost to follow-up. Forty-five participants performed at least one treatment, of which 39 participants completed a test treatment with REN. One device-related adverse event (2%) was reported in which a temporary feeling of pain in the arm was felt. Pain relief and pain-free at 2 hours were achieved by 71% (28/39) and 35% (14/39) participants, respectively. At 2 hours, 69% (23/33) participants experienced improvement in functional ability.

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Section: Introductionmentioning

confidence: 99%

Remote electrical neuromodulation for acute treatment of migraine in adolescents

Hershey

Lin²,

Gruper³

et al. 2020

Headache

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“…First, evidence‐based treatment options in youth remain limited. While many adolescents will respond to first‐line preventive medications or even placebo when coupled with consistent education about headache hygiene and evidence‐based acute migraine treatment, approximately a third do not respond to this first‐line treatment . Even among adolescents with chronic migraine receiving combined therapy with amitriptyline and cognitive behavioral therapy (CBT), 53% did not reach the goal of ≤4 headaches per month after 20 weeks.…”

Section: Introductionmentioning

confidence: 99%

Improving the Patient Experience With Migraine Camp, a One‐Day Group Intervention for Adolescents With Chronic Headache and Their Parents

Hall

Karvounides

Gelfand³

et al. 2019

Headache

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Though chronic migraine is actually common in adolescents, living with constant headache can be isolating for both patients and their families. As an outgrowth of clinical care, we developed the Miles for Migraine Youth Camp, a recurring 1‐day event for adolescents with chronic headache and their parents. Migraine Camp was developed to provide expanded headache education, teach coping strategies for living with chronic pain, and encourage development of a supportive community for adolescents living with chronic headache disorders and their families. The creation and curriculum of the Camps at the University of California San Francisco and Children's Hospital of Philadelphia are described in this manuscript, along with patient and caregiver feedback. Overall, feedback was positive. Teens reported feeling less isolated and more prepared to cope with headaches using new strategies. Both patients and caregivers consistently described benefit from connecting with others who experience similar challenges. The Migraine Camp teams at both institutions found it feasible to conduct the Camps 1‐2 times per year using existing resources, but noted that to scale it to a more regular event additional administrative and/or volunteer support would be needed. In summary, the experience has been positive for patients, caregivers, and staff, and we hope that this manuscript can serve as a “how to” model for similar events at other institutions.

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“…Several previous studies have investigated the prediction of the outcome of migraine treatment. In patients with headache, genetic factors, migraine characteristics, and autonomic symptoms have been evaluated to predict treatment response to triptan and topiramate (26)(27)(28). In addition, white matter hyperintensity was found to predict migraine prognosis (29); however, the correlation and regression analysis between predictors and patient outcomes used in this previous study were insufficient.…”

Section: Discussionmentioning

confidence: 85%

Baseline Brain Gray Matter Volume as a Predictor of Acupuncture Outcome in Treating Migraine

Yang

Liu

et al. 2020

Front. Neurol.

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Background: The present study aimed to investigate the use of imaging biomarkers to predict the outcome of acupuncture in patients with migraine without aura (MwoA). Methods: Forty-one patients with MwoA received 4 weeks of acupuncture treatment and two brain imaging sessions at the Beijing Traditional Chinese Medicine Hospital affiliated with Capital Medical University. Patients kept a headache diary for 4 weeks before treatment and during acupuncture treatment. Responders were defined as those with at least a 50% reduction in the number of migraine days. The machine learning method was used to distinguish responders from non-responders based on pre-treatment brain gray matter (GM) volume. Longitudinal changes in GM predictive regions were also analyzed. Results: After 4 weeks of acupuncture, 19 patients were classified as responders. Based on 10-fold cross-validation for the selection of GM features, the linear support vector machine produced a classification model with 73% sensitivity, 85% specificity, and 83% accuracy. The area under the receiver operating characteristic curve was 0.7871. This classification model included 10 GM areas that were mainly distributed in the frontal, temporal, parietal, precuneus, and cuneus gyri. The reduction in the number of migraine days was correlated with baseline GM volume in the cuneus, parietal, and frontal gyri in all patients. Moreover, the left cuneus showed a longitudinal increase in GM volume in responders. Conclusion: The results suggest that pre-treatment brain structure could be a novel predictor of the outcome of acupuncture in the treatment of MwoA. Imaging features could be a useful tool for the prediction of acupuncture efficacy, which would enable the development of a personalized medicine strategy.

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Predictors of Triptan Response in Pediatric Migraine

Cited by 15 publications

References 30 publications

Remote electrical neuromodulation for acute treatment of migraine in adolescents

Remote electrical neuromodulation for acute treatment of migraine in adolescents

Improving the Patient Experience With Migraine Camp, a One‐Day Group Intervention for Adolescents With Chronic Headache and Their Parents

Baseline Brain Gray Matter Volume as a Predictor of Acupuncture Outcome in Treating Migraine

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