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Stone JE, Campbell C, Tabor JB, Bonfield S, Machan M, Shan RLP, Debert CT. Ultrasound guided platelet rich plasma injections for post-traumatic greater occipital neuralgia following concussion: a pilot randomized controlled trial. Front Neurol 2024; 15:1400057. [PMID: 38911584 PMCID: PMC11191875 DOI: 10.3389/fneur.2024.1400057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/15/2024] [Indexed: 06/25/2024] Open
Abstract
Background Treatment for post-traumatic greater occipital neuralgia (GON) includes serial injections of steroid/anesthetic. While these injections can alleviate pain, effects can be transient, frequently lasting only 1 month. As a potential alternative, platelet-rich plasma (PRP) injections are an emerging biological treatment with beneficial effects in peripheral nerve disorders. We investigated the feasibility, safety, and effectiveness of a single PRP injection for post-traumatic GON in comparison to saline or steroid/anesthetic injection. Methods In this pilot randomized, double-blinded, placebo-controlled trial, 32 adults with post-traumatic GON were allocated 1:1:1 to receive a single ultrasound-guided injection of (1) autologous PRP (2) steroid/anesthetic or (3) normal saline. Our primary outcome was feasibility (recruitment, attendance, retention) and safety (adverse events). Exploratory measures included headache intensity and frequency (daily headache diaries) and additional questionnaires (headache impact, and quality of life) assessed at pre-injection, 1 week, 1 month, and 3 months post-injection. Results We screened 67 individuals, 55% were eligible and 95% of those participated. Over 80% of daily headache diaries were completed with 91% of participants completing the 3-month outcome questionnaires. No serious adverse events were reported. There were no significant differences between groups for headache intensity or frequency. Headache impact on function test-6 scores improved at 3 month in the PRP (β = -9.7, 95% CI [-15.6, -3.74], p = 0.002) and saline (β = -6.7 [-12.7, -0.57], p = 0.033) groups but not steroid/anesthetic group (p = 0.135). Conclusion PRP is a feasible and safe method for treating post-traumatic GON with comparable results to saline and steroid/anaesthetic. Further trials with larger sample sizes are required.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT04051203.
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Affiliation(s)
- Jacqueline E. Stone
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christina Campbell
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jason B. Tabor
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Stephan Bonfield
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Matthew Machan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rodney Li Pi Shan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Chantel T. Debert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Cortel-LeBlanc MA, Orr SL, Dunn M, James D, Cortel-LeBlanc A. Managing and Preventing Migraine in the Emergency Department: A Review. Ann Emerg Med 2023; 82:732-751. [PMID: 37436346 DOI: 10.1016/j.annemergmed.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 07/13/2023]
Abstract
Migraine is a leading cause of disability worldwide, and acute migraine attacks are a common reason for patients to seek care in the emergency department (ED). There have been recent advancements in the care of patients with migraine, specifically emerging evidence for nerve blocks and new pharmacological classes of medications like gepants and ditans. This article serves as a comprehensive review of migraine in the ED, including diagnosis and management of acute complications of migraine (eg, status migrainosus, migrainous infarct, persistent aura without infarction, and aura-triggered seizure) and use of evidence-based migraine-specific treatments in the ED. It highlights the role of migraine preventive medications and provides a framework for emergency physicians to prescribe them to eligible patients. Finally, it evaluates the evidence for nerve blocks in the treatment of migraine and introduces the possible role of gepants and ditans in the care of patients with migraine in the ED.
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Affiliation(s)
- Miguel A Cortel-LeBlanc
- Department of Emergency Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; 360 Concussion Care, Ottawa, ON, Canada.
| | - Serena L Orr
- Departments of Pediatrics, Community Health Sciences, and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Maeghan Dunn
- Department of Emergency Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada
| | - Daniel James
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Achelle Cortel-LeBlanc
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; 360 Concussion Care, Ottawa, ON, Canada; Division of Neurology, Department of Medicine, Queensway Carleton Hospital, Ottawa, ON, Canada
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Gaelen JI, King MR, Hajduk J, Vargas A, Krodel DJ, Shah RD, Benzon HA. Ultrasound-Guided Occipital Nerve Blocks as Part of Multi-Modal Perioperative Analgesia in Pediatric Posterior Craniotomies: A Case Series. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1374. [PMID: 37628373 PMCID: PMC10453530 DOI: 10.3390/children10081374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Various regional anesthetics have been used for postoperative analgesia for pediatric craniotomy. In this case series, we report retrospectively collected data on postoperative pain and analgesic use in 44 patients who received ultrasound-guided occipital nerve blocks in addition to intravenous analgesic agents for posterior craniotomy procedures. In the immediate post-anesthesia care unit, pain was rated as zero or well controlled in 77% of patients, with only 43% requiring intravenous or demand patient-controlled analgesia opioids. There were no block-related complications. Occipital nerve blocks may constitute a safe and effective component of multimodal analgesia in this population.
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Affiliation(s)
- Jordan I. Gaelen
- Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Eberhard SW, Subramanian S, Jackman CT. Cranial Neuralgias in Children and Adolescents A review of the literature. Semin Pediatr Neurol 2021; 40:100926. [PMID: 34749913 DOI: 10.1016/j.spen.2021.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022]
Abstract
Cranial neuralgias are a well-established cause of headache-related morbidity in the adult population. These disorders are poorly studied in general due to their relative rarity, particularly in children and adolescents, and they are likely underdiagnosed in these populations. Recognizing these disorders and differentiating them from more common headache disorders, such as migraine, is important, as secondary disease is common. This review will cover the basic epidemiology, diagnosis, and treatment of trigeminal, occipital, glossopharyngeal and other, less common, cranial neuralgias. We have reviewed pediatric case reports of these conditions. For trigeminal neuralgia, the most common of these disorders, we have compiled the clinical features and treatment response of previous reports.
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Affiliation(s)
- Spencer W Eberhard
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Sharmada Subramanian
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Christopher T Jackman
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.
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5
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Son HJ, Lee KH. Effects of Occipital Nerve Block in Pediatric Patients with Occipital Region Headache. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2021.00507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Purpose: The aim of this study was to investigate the effects of occipital nerve block (ONB) in pediatric patients with headache in the occipital region.Methods: Among 302 patients who visited our headache clinic during a 2-year period, we retrospectively reviewed the charts of 26 patients who complained of primary headache in the occipital region, and divided them into two groups according to the main treatment: ONB or oral drug treatment (ODT).Results: The mean age of the 26 patients was 11.7±3.2 years. No statistically significant differences were found between the ONB and ODT groups in age, sex, sites of pain, duration of having experienced symptoms, and the duration, frequency, and severity of episodes (P>0.05). There was no statistically significant difference in remission between the ONB and ODT groups. However, in the ONB group, the time taken to achieve remission was significantly shorter than in the ODT group (P<0.05). Additionally, in the ONB group, the duration of medication and the period of outpatient treatment were significantly shorter than in the ODT group (P<0.05).Conclusion: In this study, ONB reduced the time taken to achieve remission and shortened the period of treatment. Thus, ONB should be considered in pediatric patients with headache in the occipital region.
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Abstract
Pediatric headache impacts up to 80% of children, many recurrently, by the time they are 15 years old. Preventing the progression of episodic to chronic headache results in less truancy, staying current with schoolwork and improves children's quality of life. Lifestyle choices can play an important role in headache treatment. Early effective treatment of episodic headache can prevent transformation into a chronic form. While details of a child's headache are critical for making a proper diagnosis; patient education is critical and effective rescue and preventive treatment strategies enable patients to focus on enjoying activities of daily living. Recognizing "red flags" that may suggest a serious underlying etiology is critical in the early stages of diagnosing and preparing to treat children with headaches. Finally directing patients to manage their headaches at home and when to proceed to an emergency department, urgent care or infusion unit can lower the economic burden of acute headache management.
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Affiliation(s)
- Debra M O'Donnell
- Pediatric Neurologist, Dayton Children's Hospital, Division of Neurology, OH, United States.
| | - Anastazia Agin
- Pediatrician and Headache Specialist, Dayton Children's Hospital, Division of Neurology, OH, United States
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Antonsen C, Tsingos M, Pascual A. Unilateral Headache with Scalp and Hair Pain in an 8-year-old Boy. Pediatr Rev 2021; 42:S71-S73. [PMID: 33386367 DOI: 10.1542/pir.2019-0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Camilla Antonsen
- Pediatric Department, Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland;
| | - Marianthi Tsingos
- Pediatric Department, Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland.,General Pediatric Department, Geneva University Hospital, Geneva, Switzerland
| | - Andrés Pascual
- Pediatric Department, Groupement Hospitalier de l'Ouest Lémanique, Nyon, Switzerland
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Urits I, Schwartz RH, Patel P, Zeien J, Connor D, Hasoon J, Berger AA, Kassem H, Manchikanti L, Kaye AD, Viswanath O. A Review of the Recent Findings in Minimally Invasive Treatment Options for the Management of Occipital Neuralgia. Neurol Ther 2020; 9:229-241. [PMID: 32488840 PMCID: PMC7606364 DOI: 10.1007/s40120-020-00197-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 02/06/2023] Open
Abstract
Occipital neuralgia (ON) is unilateral or bilateral neuralgia in the dermatomal nerve distribution of the greater, lesser or third occipital nerves and is a very common presentation of neuropathic pain. ON, although common and well defined, is still a poorly understood pain syndrome. It often requires invasive treatment for long term and significant pain alleviation; however, the evidence supporting different options is still limited. Several minimally invasive techniques have proven to be efficacious and safe, and the selection depends mostly on response to nerve blocks, patient choice and provider preference. This is a comprehensive review of the latest and seminal literature available about occipital neuralgia and currently available minimally invasive treatment options. It covers the anatomical and physiologic biology at the base of neuralgia, the presentation and diagnostic process. It then reviews the available literature to provide description and comparison of the available methods for alleviation.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Ruben H Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
| | - Parth Patel
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Justin Zeien
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Denton Connor
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Amnon A Berger
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami, FL, USA
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
- Envision Physician Services, Phoenix, AZ, USA
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9
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Pavlova M, Orr SL, Noel M. Parent-Child Reminiscing about Past Pain as a Preparatory Technique in the Context of Children's Pain: A Narrative Review and Call for Future Research. CHILDREN-BASEL 2020; 7:children7090130. [PMID: 32906595 PMCID: PMC7552681 DOI: 10.3390/children7090130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
Pain permeates childhood and remains inadequately and/or inconsistently managed. Existing research and clinical practice guidelines have largely focused on factors influencing the immediate experience of pain. The need for and benefits of preparing children for future pain (e.g., painful procedures) has been well established. Despite being a robust predictor of future pain and distress, memories of past painful experiences remain overlooked in pediatric pain management. Just as autobiographical memories prepare us for the future, children’s memories for past pain can be harnessed to prepare children for future painful experiences. Children’s pain memories are malleable and can be reframed to be less distressing, thus reducing anticipatory distress and promoting self-efficacy. Parents are powerful agents of change in the context of pediatric pain and valuable historians of children’s past painful experiences. They can alter children’s pain memories to be less distressing simply by talking, or reminiscing, about past pain. This narrative review summarizes existing research on parent–child reminiscing in the context of acute and chronic pediatric pain and argues for incorporation of parent–child reminiscing elements into preparatory interventions for painful procedures.
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Affiliation(s)
- Maria Pavlova
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Serena L. Orr
- Department of Pediatrics, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada;
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Hotchkiss Brain Institute, Owerko Centre, Alberta Children’s Hospital Research Institute, Calgary, AB T3B 6A8, Canada
- Correspondence: ; Tel.: +1-403-220-4969
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Shauly O, Gould DJ, Patel KM. The Public's Perception of Interventions for Migraine Headache Disorders: A Crowdsourcing Population-Based Study. AESTHETIC SURGERY JOURNAL OPEN FORUM 2019; 1:ojz007. [PMID: 33791603 PMCID: PMC7670936 DOI: 10.1093/asjof/ojz007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Migraine disorders are a leading cause of morbidity and decreased economic productivity
in the United States among both men and women. As such, it is important to consider
patient opinions, and have an accurate representation of the burden and sentiment toward
currently available interventions among those suffering from migraines. Objectives The aim of the study was to assess patient options regarding adverse outcomes of the
various treatment options available for migraine headaches. Methods A prospective cross-sectional study of volunteers recruited through an internet
crowdsourcing service, Amazon Mechanical Turk©, was conducted. Surveys were administered
to collect patient-reported opinions regarding adverse outcomes of both surgical and
nonsurgical treatment options for migraine headaches. Results The prevalence of migraine headache across all study participants was 15.6% and varied
slightly across participant demographics. Individuals ages 35–44 (2.73 migraines per
month) experienced the fewest migraine and with the lowest severity. Those individuals
ages 45+ experienced the most severe headaches (Visual Analog Scale = 44.23 mm).
Additionally, the greatest migraine frequency and severity existed among those
households with yearly income of $75,000–$100,000. The lowest injection therapy utility
scores were obtained for adverse outcomes of hematoma (47.60 mm) and vertigo (54.40
mm). Conclusions Migraine headaches remains a significant problem among the US population, with an
overall prevalence of 15.6% (approximately 50 million Americans). Additionally,
physicians interesting in offering minimally invasive or surgical treatment for migraine
headaches should focus on mitigating patient fears regarding clinical outcomes and cost
of care.
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Affiliation(s)
- Orr Shauly
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Daniel J Gould
- Keck Hospital of University of Southern California, Los Angeles, CA
| | - Ketan M Patel
- Keck Hospital of University of Southern California, Los Angeles, CA
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Abstract
PURPOSE OF REVIEW Headaches in children and adolescents are common, causing debilitating symptoms in many. Treatment of headache disorders can be complex and standard lifestyle changes as well as oral medications may offer inadequate relief. The purpose of this article is to review the mechanism of action, efficacy and technique of peripheral nerve blocks (PNBs) and the role they play in treating paediatric headache disorders. RECENT FINDINGS Evidence for the use of PNBs in youth is limited. However, available studies show evidence of benefit in both primary and secondary headache disorders. Variability exists in the type of block, medication choice, volume infused and frequency of this treatment. There are no serious side effects associated with PNBs. SUMMARY PNBs are well tolerated and effective as adjunctive therapy for many disabling paediatric headache disorders. The technique can be easily learned by frontline and specialty practitioners. Prospective placebo-controlled studies are needed to determine how to best maximize PNBs for headache management (i.e. medication choice, timing and so on).
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Arruda MA, Chevis CF, Bigal ME. Recent advances in the management of chronic migraine in children. Expert Rev Neurother 2018; 18:231-239. [PMID: 29429363 DOI: 10.1080/14737175.2018.1438191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Migraine is a chronic-recurrent disorder that progresses in some adults and also in many children. Chronic migraine (CM) is the clinical result of this process. Since migraine does not progress in most children, identifying the risk factors for progression is an important public health priority that should be matched by evidence-based treatment. Areas covered: Herein we conduct a systematic review on the comorbidities and treatment of CM in children and adolescents in the last ten years, summarizing evidence-based recommendations for disease management. Expert commentary: By conceptualizing CM as the result of migraine progression from an episodic form, we suggest avoiding CM at the outset through development of aggressive, preventive interventions as the goal of headache management in the pediatric population. Key interventions include: Decreasing headache frequency with behavioral and pharmacologic interventions; Monitoring body mass index and encouraging maintenance of normal weight; Avoiding medication overuse; Screening and treating comorbidities.
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