Prophylactic Drug Treatment of Migraine in Children and Adolescents: An Update

Tajti, János; Delia, S.; Csáti, Anett; Vécsei, László

doi:10.1007/s11916-015-0536-6

Cited by 37 publications

(26 citation statements)

References 69 publications

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“…Although the pathomechanism of migraine is not fully understood, there are treatments that have been effective in the adult population that are not even specific for migraine such as antidepressants, antiepileptics, antihistamines, calcium ion channel antagonists, and betaadrenergic receptor blockers. These are also being utilized in the pediatric population, however, on a smaller scale, as data from adult studies are often extrapolated and applied to the pediatric population as well [25][26]. There have been mixed results with this approach for pediatric patients who do receive such treatment, and although it appears that many of these preventative medications are safe, there is a concern that pharmacological interventions may have the potential to present more risk than benefits in this population and, therefore, despite experiencing significant disability, a large number of pediatric migraineurs do not receive prophylactic therapy [25].…”

Section: Discussionmentioning

confidence: 99%

Further Evidence that Onabotulinum Toxin is a Viable Treatment Option for Pediatric Chronic Migraine Patients

Ali¹,

Bragin²,

Rende³

et al. 2019

Cureus

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Introduction Chronic migraine is particularly devastating. It affects school work, extracurricular activities, and quality of life, including relationships with other family members, and can also influence the mental health of both the migraineurs and family members. According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), chronic migraine is defined as 15 or more headache days per month for greater than three months, where at least on eight days per month, there are features of migraine headache. Although botulinum toxin type A (BoNTA) has been proven effective for treating chronic migraine in adults, little literature exists about its use in children. Here, we present the treatment response in children with chronic migraines treated with BoNTA at our institutions Duke and State University of New York (SUNY) Upstate. Method A retrospective analysis of 30 adolescent migraineurs who met ICHD-3 criteria for chronic migraine were treated with BoNTA injection according to the standardized adult protocol. Descriptive statistics and paired t-tests were performed. A total of 185 units of botulinum toxin were injected intramuscularly per patient, as in addition to the standard 31 sites for a total of 155 units, an additional 30 units were given in areas that were felt to provide further benefit. Results Participants (n=30) were 16.5 ± 1.83 years old. The headaches were precipitated by trauma in seven cases. All had failed standard pharmacotherapy, including amitriptyline and topiramate. An average of 2.47 ± 1.6 BoNTA injection cycles was performed. Migraine severity decreased significantly from 7.47 ± 1.89 on a 10-point scale to 4.34 ± 3.02 (p<.001). Additionally, headache frequency improved from 24.4 ± 7.49 painful days per month to 14.8 ± 12.52 painful days per month (p<.001). One patient developed nausea related to injections; all others tolerated it well, with no side effects. Discussion BoNTA injection was a safe and effective therapy for chronic migraine in our cohort of children recalcitrant to medical therapy. Further research with multi-centered, double-blinded, randomized, placebo-controlled trials is warranted to evaluate the long-term safety and efficacy in this population.

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Section: Discussionmentioning

confidence: 99%

Further Evidence that Onabotulinum Toxin is a Viable Treatment Option for Pediatric Chronic Migraine Patients

Ali¹,

Bragin²,

Rende³

et al. 2019

Cureus

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“…Patients with incomplete SCIs benefit most from rehabilitation as they retain some level of motor functionality. 26 The process can take months and even years to help patients regain strength. Concurrently, the medical cost for treatment is proportionately high as well.…”

Section: Introductionmentioning

confidence: 99%

Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management

Ikpeze

Mesfin

2017

Geriatr Orthop Surg Rehabil

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Spinal cord injuries (SCIs) are sustained by more than 12 500 patients per year in the United States and more globally. The SCIs disproportionately affect the elderly, especially men. Approximately 60% of these injuries are sustained traumatically through falls, but nontraumatic causes including infections, tumors, and medication-related epidural bleeding have also been documented. Preexisting conditions such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis can render the spine stiff and are risk factors as well as cervical spondylosis and ensuing cervical stenosis. Treatment options vary depending on the severity, location, and complexity of the injury. Surgical management has been growing in popularity over the years and remains an option as it helps reduce spinal cord compression and alleviate pain. Elevating mean arterial pressures to prevent spinal cord ischemia and avoiding the second hit of SCI have become more common as opposed to high dose steroids. Ongoing clinical trials with pharmacological agents such as minocycline and riluzole have shown early, promising results in their ability to reduce cellular damage and facilitate recovery. Though SCI can be life changing, the available treatment options have aimed to reduce pain and minimize complications and maintain quality of life alongside rehabilitative services.

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“…Most of our patients reported a relatively low level of formal education, which was consistent with our previous study [ 5 ]. These patients with CM had an average duration of migraine attacks of 17.4 years, although this is shorter than in another recent study [ 28 ]. We note that 82.5 % of our patients took acute analgesics, and 67.6 % had MOH, which was similar to other studies [ 16 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 63%

Field testing of the ICHD-3β and expert opinion criteria for chronic migraine

et al. 2016

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BackgroundChronic headache (CrH) occurs commonly in the population, and chronic migraine (CM) accounts for much of the CrH. Diagnostic criteria for CM remain controversial, and this could lead to undertreatment of CM. The purpose of this study was to analyze the clinical profiles of CM and to field test the International Classification of Headache Disorders-3β criteria (ICHD-3β) and Expert Opinion criteria (EO) for CM application.MethodsWe retrospectively reviewed the medical records of CrH patients in our headache clinic during the period. Eligible patients were selected from CrH population based on Silberstein and Lipton criteria (S-L) for CM, and meanwhile fulfilled with migraine days at least 8 days/month. Then we evaluated the characteristics of clinic profiles and outcomes between patients diagnosed CM using ICHD-3β and EO criteria. Field tested the CM criteria Of ICHD-3β and EO.ResultsIn a total of 710 CrH patients , 261 (36.8 %) were recruited with CM based on both S-L criteria and fulfilled at least 8 migraine days/month. Be understandable, all the 261 patients met the EO criteria, and only 185 (70.9 %) met ICHD-3β for CM. For the 76 patients who met EO but not ICHD-3β, 70 had atypical migraine attacks (probable migraine, PM), and another 6 had typical migraine attacks but less than a total history of 5 attacks. Although 173 (66.3 %) were concurrent with medication overuse, just one patient overused triptans and none used ergot agents. Clinical features were not significantly different between the ICHD-3β and EO criteria groups (P > 0.05), and neither were outcomes of prophylaxis (P = 0.966). Total migraine prophylaxis effectiveness was 73 %.ConclusionMigraine-specific analgesics are rarely used in China, permitting patients with PM to avail themselves of “migraine days” is a reasonable accommodation for this difficult condition. In our hands, use of the new EO criteria for diagnosis of CM increases the sensitivity and maintains the specificity of decision making, and therefore should be adopted in CM management practice.

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Prophylactic Drug Treatment of Migraine in Children and Adolescents: An Update

Cited by 37 publications

References 69 publications

Further Evidence that Onabotulinum Toxin is a Viable Treatment Option for Pediatric Chronic Migraine Patients

Further Evidence that Onabotulinum Toxin is a Viable Treatment Option for Pediatric Chronic Migraine Patients

Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management

Field testing of the ICHD-3β and expert opinion criteria for chronic migraine

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