The spectrum of indomethacin-responsive headaches in children and adolescents

Myers, Kenneth A.; Barmherzig, Rebecca; Raj, Nichelle; Berrahmoune, Saoussen; Ingelmo, Pablo; Saint‐Martin, Christine; Khan, Afsheen Q; Kouri, Megan; Morris, Cynthia D.; Hershey, Andrew D.; Kacperski, Joanne; Kabbouche, Marielle A.; Mohamed, Nada; Rao, Rashmi; Lagman-Bartolome, Ana Marissa; Gelfand, Amy A.; Szperka, Christina L.; Orr, Serena L.

doi:10.1177/03331024221076483

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…96 Existing summative data suggest that the trigeminal autonomic cephalalgias may present differently in children and adolescents compared with adults, with more associated migraine features and different attack frequencies as well as pain locations that may deviate from the ICHD-3 criteria. 96,97 To make an accurate diagnosis and avoid prolonged delays in diagnosis, clinicians must maintain a high index of suspicion for trigeminal autonomic cephalalgias. One key consideration when seeing a child or adolescent with headache is whether they may have an indomethacin-responsive headache disorder.…”

Section: Trigeminal Autonomic Cephalalgiasmentioning

confidence: 99%

“…Although rare, it is important not to miss these cases, as these patients may be absolutely responsive to indomethacin and establishing the correct diagnosis and treatment can be curative. Recent data from the largest reported case series of pediatric-onset indomethacin-responsive headache disorders provide some guidance to clinicians regarding when to consider an indomethacin trial 97 :…”

Section: Trigeminal Autonomic Cephalalgiasmentioning

confidence: 99%

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Headache in Children and Adolescents

Orr

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article reviews the assessment of children and adolescents presenting with headache, provides an overview of primary headache disorders, and reviews evidence-based management of headache in this age group. LATEST DEVELOPMENTS In the last few years, new epidemiological data have shed light on less common pediatric headache disorders (eg, pediatric trigeminal autonomic cephalalgias) and psychosocial risk factors associated with primary headache disorders in children and adolescents. There has also recently been a substantial increase in interventions that target the calcitonin gene-related peptide pathway and that treat primary headache disorders using noninvasive neuromodulation. Although these interventions have primarily been studied in adults, there is emerging evidence of their use in the pediatric population. ESSENTIAL POINTS Primary headache disorders are very common in youth, and the most commonly encountered headache diagnosis in neurology practice is migraine, which affects approximately 10% of children and adolescents. Diagnosing and effectively treating primary headache disorders before adulthood may have a sustained impact on the patient by improving long-term headache and mental health outcomes, thereby significantly reducing the burden of disability over time. There are several available and emerging acute and preventive interventions for youth with primary headache disorders, and treatment decisions should be made in the context of available evidence using a shared decision-making approach.

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Section: Trigeminal Autonomic Cephalalgiasmentioning

confidence: 99%

Section: Trigeminal Autonomic Cephalalgiasmentioning

confidence: 99%

Headache in Children and Adolescents

Orr

2024

CONTINUUM: Lifelong Learning in Neurology

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“…PSH has been recognized as one of indomethacin-responsive headaches (61,62). However, several other agents have also shown similar efficacy in the treatment of PSH.…”

Section: Treatmentmentioning

confidence: 99%

Epicranial headache part 1: Primary stabbing headache

2023

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Background/objective Primary stabbing headache is a common but under-recognized primary headache disorder. The objectives of this review were to provide practical information for better understanding and identification of the disease, suggest an algorithm for differential diagnosis, and provide an insight into the pathophysiology of primary stabbing headache hypothesized from its clinical course. Methods This narrative review of primary stabbing headache is based on a literature search and the authors’ clinical reasoning. Result The phenotype of each stab is typically abrupt, ultrashort-lasting (<3 s), focal or multifocal, paroxysms of pain occurring sporadically or in clusters. The diagnosis of primary stabbing headache is clinical; fixed or migrating stabs without background pain or sensory abnormalities and the absence of features suggestive of other disorders (e.g., cranial autonomic symptoms or signs) can aid in the diagnosis of primary stabbing headache. The clinical patterns include monophasic, intermittent, and chronic primary stabbing headache, of which the first two are considered typical. The pathophysiology of primary stabbing headache has not yet been elucidated. In this review, we postulated the mechanism of stabbing headache, based on the pain phenotype and clinical course, and provide a clinical algorithm for the differential diagnosis of primary stabbing headache. Conclusion Knowledge about the typical manifestations and clinical patterns of primary stabbing headache will aid in the proper diagnosis and differential diagnosis. Treatment should be tailored by considering the clinical patterns. Further research is needed to elucidate the pathophysiological mechanisms and optimal treatment of primary stabbing headache.

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“…From a series of published cohorts, the male to female ratio varies between 1:1 and 1:2.4 (3), veering more towards the former (Table 3), thus equal in men and women. The mean age of onset lies between the 4th and 5th decades, but the disorder has also been reported in the 1st (74) and 8th decades (75).…”

Section: Hemicrania Continuamentioning

confidence: 99%

Paroxysmal hemicrania and hemicrania continua: Review on pathophysiology, clinical features and treatment

Bahra

2023

Cephalalgia

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Background Paroxysmal hemicrania and hemicrania continua are indometacin-sensitive trigeminal autonomic cephalalgias, a terminology which reflects the predominant distribution of the pain, observable cranial autonomic features and shared pathophysiology. Understanding the latter is limited, both by low prevalence and the intricacies of studying brain function, requiring multimodal techniques to glean insights into such disorders. Similarly obscure is the curious response to indometacin. This review will address what is currently known about pathophysiology, the rationale for the current classification and, features which may confound the diagnosis, such as lack of cranial autonomic symptoms and those which are typically associated with migraine such as nausea, photophobia, phonophobia and aura. Despite these characteristics, a dramatic response to indometacin, which is not seen in migraine nor the other trigeminal autonomic cephalalgias , provides the hallmark of the diagnosis. The main clinical differential for paroxysmal hemicrania is based on temporal pattern and lies between cluster headache and short-lasting-neuralgiform headache attacks with tearing or additional cranial autonomic symptoms. For hemicrania continua it is more challenging as the main differential for which the disorder is often treated is migraine. A prior episodic pattern, often days at a time, and the tendency to exacerbation with analgesics will further deflect from the diagnosis. The relevance of this is that there is little overlap in therapeutics between paroxysmal hemicrania and hemicrania continua and other headache disorders and there are limited effective alternatives to indometacin. The most effective are other non-steroidal anti-inflammatory drugs including the newer COX-II inhibitors. Even though early reports suggest that a higher indometacin dose-requirement may herald a secondary precipitating pathology, this does not seem to be the case, with syndrome and response to treatment being similar with the primary disorder. In this context imaging of new onset paroxysmal hemicrania or hemicrania continua and implication of the results will be discussed as will alternative treatment options.

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The spectrum of indomethacin-responsive headaches in children and adolescents

Cited by 7 publications

References 11 publications

Headache in Children and Adolescents

Headache in Children and Adolescents

Epicranial headache part 1: Primary stabbing headache

Paroxysmal hemicrania and hemicrania continua: Review on pathophysiology, clinical features and treatment

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