Treating Migraine in Children and Adolescents—Reply

Zernikow, Boris

doi:10.1001/jamapediatrics.2020.2011

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…The current findings highlight that the quick and notable improvement in headache frequency seen in this clinical trial was not due to the pharmacological/chemical aspect of the pill-based treatment provided (12). Given that preventive medications for youth with migraine have bothersome and sometimes serious side effects, there have been increasing calls in the literature to take the lack of evidence for prevention medication seriously and to focus on non-pharmacological and coping-based treatments for youth with migraine (3,(12)(13)(14)(15). The 2020 practice guidelines from the American Academy of Neurology and the American Headache Society now recommend that, 'clinicians should engage in shared decision making with patients and caregivers regarding the use of preventive treatments for migraine, including discussion of the limitations in the evidence to support pharmacologic treatments (3, p.…”

Section: Discussionmentioning

confidence: 93%

“…Given that migraine can often be a lifelong condition, identifying biopsychosocial dimensions of treatment that can be utilized to empower children to better manage pain may be a preferred alternative (or addition) to a trial of prophylactic pharmacological treatment (15,18). The current literature suggests that cognitive behavioral therapy -a time limited psychological treatment package that includes training in relaxation skills, activity pacing, and cognitive reappraisal skills -may be a particularly beneficial treatment option for youth with migraine.…”

Section: Discussionmentioning

confidence: 99%

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Trajectory of treatment response in the child and adolescent migraine prevention (CHAMP) study: A randomized clinical trial

et al. 2021

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Objective Identify preventive medication treatment response trajectories among youth participating in the Childhood and Adolescent Migraine Prevention study. Methods Data were evaluated from 328 youth (ages 8–17). Childhood and Adolescent Migraine Prevention study participants completed headache diaries during a 28-day baseline period and a 168-day active treatment period during which youth took amitriptyline, topiramate, or placebo. Daily headache occurrence trajectories were established across baseline and active treatment periods using longitudinal hierarchical linear modeling. We tested potential treatment group differences. We also compared final models to trajectory findings from a clinical trial of cognitive behavioral therapy plus amitriptyline for youth with chronic migraine to test for reproducibility. Results Daily headache occurrence showed stability across baseline. Active treatment models revealed decreases in headache frequency that were most notable early in the trial period. Baseline and active treatment models did not differ by treatment group and replicated trajectory cognitive behavioral therapy plus amitriptyline trial findings. Conclusions Replicating headache frequency trajectories across clinical trials provides strong evidence that youth can improve quickly. Given no effect for medication, we need to better understand what drives this clinically meaningful improvement. Results also suggest an expected trajectory of treatment response for use in designing and determining endpoints for future clinical trials. Trial Registration. ClinicalTrials.gov Identifier: NCT01581281

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Trajectory of treatment response in the child and adolescent migraine prevention (CHAMP) study: A randomized clinical trial

et al. 2021

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Who Gets Referred? A Pilot Study of Risk Stratification and Treatment Referral in Pediatric Headache Using the Pediatric Pain Screening Tool

Salamon

Carlson

Hildenbrand

2021

Journal of Pediatric Psychology

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Objective Headaches are common among youth and are associated with significant negative outcomes. Despite advances in interdisciplinary treatments for youth with chronic pain, research suggests disparities in access to these services. Methods A total of 186 youth (M = 14.19 years old, 70.8% female) presenting to a neurology appointment at a children’s hospital system were screened using the Pediatric Pain Screening Tool (PPST), a brief, validated measure to identify youth that may benefit from additional pain management services. Results Two-thirds of participants (n = 124, 66.7%) screened as medium or high risk on the PPST. Risk categorization did not vary by patient age or sex. A greater proportion of Hispanic/Latino patients were categorized as low-risk relative to non-Hispanic/Latino patients (55.6% vs. 30.1%), and a somewhat lower proportion of patients of color were categorized as medium-risk relative to White patients (14.0% vs. 30.5%). Three-quarters (n = 94, 75.8%) of patients who were screened as medium or high risk were not referred for any additional pain management services. Referrals did not vary by patient age or ethnicity. While not statistically significant, a lower proportion of males received referrals at both medium (8.3% vs. 17.6%) and high levels of risk (15.8% vs. 34.5%), and a greater proportion of youth of color who screened as medium risk received referrals relative to White youth categorized as medium risk (37.5% vs. 10.3%). Conclusion Future research should continue to explore factors influencing decision-making regarding referral to specialized pain management services for youth with headache.

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Introduction to Special Section: Innovations in Pediatric Headache Research

Law

Connelly

2022

Journal of Pediatric Psychology

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Treating Migraine in Children and Adolescents—Reply

Abstract: Press, and Wolters Kluwer; and a patent magnetic stimulation for headache assigned to eNeura without fee.1. Zernikow B. Can we really stop pediatric migraine? using network meta-analysis to remove the guess work.

Cited by 3 publications

References 8 publications

Trajectory of treatment response in the child and adolescent migraine prevention (CHAMP) study: A randomized clinical trial

Trajectory of treatment response in the child and adolescent migraine prevention (CHAMP) study: A randomized clinical trial

Who Gets Referred? A Pilot Study of Risk Stratification and Treatment Referral in Pediatric Headache Using the Pediatric Pain Screening Tool

Introduction to Special Section: Innovations in Pediatric Headache Research

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