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Iannone LF, De Cesaris F, Geppetti P. Emerging Pharmacological Treatments for Migraine in the Pediatric Population. Life (Basel) 2022; 12:536. [PMID: 35455026 PMCID: PMC9031827 DOI: 10.3390/life12040536,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 12/07/2023] Open
Abstract
Headaches in children and adolescents have high incidence and prevalence rates, with consequent elevated disability costs to individuals and the community. Pediatric migraine is a disorder with substantial clinical differences compared to the adult form. Few clinical trials have been performed specifically on primary headache in pediatric populations using acute and preventative treatments, often with conflicting findings. The limited high-quality data on the effectiveness of treatments are also due to the high placebo effect, in terms of reductions in both the frequency and intensity of migraine attacks in the pediatric population. The recent introduction of calcitonin gene-related peptide (CGRP) pathway inhibitors and ditans is changing the treatment of migraine, but the majority of the data are still limited to adulthood. Thus, few drugs have indications for migraine treatment in the pediatric age group, and limited evidence gives guidance as to the choice of pharmacotherapy. Herein, we review the current evidence of pharmacological treatments and ongoing clinical trials on acute and preventative treatments in the pediatric population with migraine.
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Affiliation(s)
- Luigi Francesco Iannone
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, 50121 Florence, Italy;
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Francesco De Cesaris
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Pierangelo Geppetti
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, 50121 Florence, Italy;
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, 50134 Florence, Italy;
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Iannone LF, De Cesaris F, Geppetti P. Emerging Pharmacological Treatments for Migraine in the Pediatric Population. Life (Basel) 2022; 12:life12040536. [PMID: 35455026 PMCID: PMC9031827 DOI: 10.3390/life12040536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
Headaches in children and adolescents have high incidence and prevalence rates, with consequent elevated disability costs to individuals and the community. Pediatric migraine is a disorder with substantial clinical differences compared to the adult form. Few clinical trials have been performed specifically on primary headache in pediatric populations using acute and preventative treatments, often with conflicting findings. The limited high-quality data on the effectiveness of treatments are also due to the high placebo effect, in terms of reductions in both the frequency and intensity of migraine attacks in the pediatric population. The recent introduction of calcitonin gene-related peptide (CGRP) pathway inhibitors and ditans is changing the treatment of migraine, but the majority of the data are still limited to adulthood. Thus, few drugs have indications for migraine treatment in the pediatric age group, and limited evidence gives guidance as to the choice of pharmacotherapy. Herein, we review the current evidence of pharmacological treatments and ongoing clinical trials on acute and preventative treatments in the pediatric population with migraine.
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Affiliation(s)
- Luigi Francesco Iannone
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, 50121 Florence, Italy;
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Francesco De Cesaris
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Pierangelo Geppetti
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, 50121 Florence, Italy;
- Headache Center and Clinical Pharmacology Unit, Careggi University Hospital, 50134 Florence, Italy;
- Correspondence:
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Sweeney B, Kelly AS, San Giovanni CB, Kelsey MM, Skelton JA. Clinical approaches to minimize iatrogenic weight gain in children and adolescents. Clin Obes 2021; 11:e12417. [PMID: 32987450 DOI: 10.1111/cob.12417] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
Clinical providers may underestimate the role of management of diseases that can occur with obesity, termed co-morbid conditions, distinct from disease that arise as a result of obesity, co-morbidities. Many of these conditions are associated with iatrogenic weight gain, and can interfere with weight loss outcomes in children and adolescents with obesity. Management of co-morbid conditions, and thoughtful selection of medications associated with weight neutrality or weight loss may increase the effectiveness of obesity treatment strategies. The aim of this commentary is to summarize the literature and discuss considerations for obesity treatment in the context of the more complicated patient, which often requires strategic management of co-morbid conditions and minimizing iatrogenic weight gain.
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Affiliation(s)
- Brooke Sweeney
- Department of Pediatrics, University of Missouri, Kansas City, Missouri, USA
| | - Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Megan M Kelsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Abstract
AIMS To conduct a review of the literature on the use of botulinum toxin for the treatment of pediatric chronic migraine. METHODS A review of the literature was performed using EMBASE, PubMed, and Cochrane/Ovid. Using our inclusion and exclusion criteria, we targeted any study, published before April 2020, evaluating the efficacy of botulinum toxin in migraineurs younger than 18 years. RESULTS Seven studies were included: 2 retrospective analyses, 3 case series, a case report, and a randomized control trial. Studies included 1 to 125 patients, with the number of botulinum toxin treatments ranging from 1 to 11 treatments. The results of the randomized controlled trial showed nonsuperiority between placebo and botulinum toxin. Results of the other studies were generally favorable but were difficult to compare because of lack of standardization of botulinum toxin dosing, injection paradigm, frequency and duration of treatment, usage of accompanying prophylaxis, and variation in outcome measures across studies. There was low-quality evidence that botulinum toxin improved headache frequency and intensity, though some studies demonstrated efficacy in treatment with botulinum toxin. CONCLUSION This review is the first of its kind, updating the literature on the efficacy of botulinum toxin in pediatric patients. Given evidence of its utility in treating pediatric migraines, off-label use should be considered in certain cases. Further study is warranted to better characterize injection paradigms and patient selection because of the limited and inconsistent data available.
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Affiliation(s)
- Raymundo Marcelo
- 158147Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Brin Freund
- 158147Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,Department of Neurology, 1501Johns Hopkins Hospital, Baltimore, MD, USA
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Birnie KA, Ouellette C, Do Amaral T, Stinson JN. Mapping the evidence and gaps of interventions for pediatric chronic pain to inform policy, research, and practice: A systematic review and quality assessment of systematic reviews. Can J Pain 2020; 4:129-148. [PMID: 33987493 PMCID: PMC7951164 DOI: 10.1080/24740527.2020.1757384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
Background: Reviews in pediatric chronic pain often focus on only one intervention or population, making it difficult for policymakers and decision makers to quickly synthesize knowledge to inform larger-scale policy and funding priorities. Aims: The aims of this study were to (1) create an evidence and gap map of interventions for pediatric chronic pain and (2) identify gaps between existing evidence and recently identified patient-oriented research priorities. Methods: We performed a systematic review of English-language peer-reviewed systematic reviews or clinical practice guidelines of pediatric chronic pain intervention published in the past 20 years. Database searches of Medline, Embase, PsycINFO, Web of Science, CINAHL, and SCOPUS were conducted inclusive to June 3, 2019. Review quality was assessed using the AMSTAR-2. Results: Of 4168 unique abstracts, 50 systematic reviews (including 2 clinical practice guidelines) crossing diverse pediatric chronic pain populations and intervention settings were included. One third were rated high quality, with half rated low to critically low quality. The largest proportion of reviews addressed psychological and pharmacological interventions, followed by interdisciplinary, other (e.g., dietary), and physical interventions. Most common outcomes included pain, physical, emotional, and role functioning and quality of life. Treatment satisfaction and adverse events were less common, with minimal report of sleep or economic factors. Most patient-oriented research priorities had not been investigated. Conclusions: Sufficient quality evidence is available to guide evidence-informed policies in pediatric chronic pain, most notably regarding psychological and pharmacological interventions. Numerous evidence gaps in patient-oriented research priorities and treatment outcomes should guide prioritization of research funds, as well as study aims and design.
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Affiliation(s)
- Kathryn A. Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Carley Ouellette
- Faculty of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Tamara Do Amaral
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Papetti L, Ursitti F, Moavero R, Ferilli MAN, Sforza G, Tarantino S, Vigevano F, Valeriani M. Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade? Front Neurol 2019; 10:771. [PMID: 31379721 PMCID: PMC6646427 DOI: 10.3389/fneur.2019.00771] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
Migraine is a frequent and very disabling disease, especially at pediatric age. Despite this, there are few controlled data on the prophylactic treatment of primary headaches in this category of age. Given that the recently introduced calcitonin gene-related peptide (CGRP) inhibitors (CGRP-r) are still limited to adulthood, there is no drug with exclusive indication for migraine treatment in pediatric age. This raises several limitations in terms of adherence and effectiveness of the therapy. Moreover, the scenario is complicated by placebo response, which is larger in children and adolescents than in adults and often leads to an improvement in the attack frequency even in absence of any active pharmacological treatment. Our aim was to investigate the real evidence concerning the prophylactic therapy of pediatric migraine by reviewing the clinical studies published between 2010 and 2019.
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Affiliation(s)
- Laura Papetti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Fabiana Ursitti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Romina Moavero
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy.,Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | | | - Giorgia Sforza
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Samuela Tarantino
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Federico Vigevano
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Massimiliano Valeriani
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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Papetti L, Salfa I, Battan B, Moavero R, Termine C, Bartoli B, Di Nunzio F, Tarantino S, Alaimo Di Loro P, Vigevano F, Valeriani M. Features of Primary Chronic Headache in Children and Adolescents and Validity of Ichd 3 Criteria. Front Neurol 2019; 10:92. [PMID: 30890994 PMCID: PMC6413701 DOI: 10.3389/fneur.2019.00092] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/23/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: Chronic headaches are not a rare condition in children and adolescents with negative effects on their quality of life. Our aims were to investigate the clinical features of chronic headache and usefulness of the International Classification of Headache Disorders 3rd edition (ICHD 3) criteria for the diagnosis in a cohort of pediatric patients. Methods: We retrospectively reviewed the charts of patients attending the Headache Center of Bambino Gesù Children and Insubria University Hospital during the 2010-2016 time interval. Statistical analysis was conducted to study possible correlations between: (a) chronic primary headache (CPH) and demographic data (age and sex), (b) CPH and headache qualitative features, (c) CPH and risk of medication overuse headache (MOH), and (d) CPH and response to prophylactic therapies. Moreover, we compared the diagnosis obtained by ICHD 3 vs. ICHD 2 criteria Results: We included 377 patients with CPH (66.4% females, 33.6% males, under 18 years of age). CPH was less frequent under 6 years of age (0.8%; p < 0.05) and there was no correlation between age/sex and different CPH types. The risk to develop MOH was higher after 15 years of age (p < 0.05). When we compared the diagnosis obtained by ICHD 2 and ICHD 3 criteria we found a significant difference for the undefined diagnosis (2.6% vs. 7.9%; p < 0.05), while the diagnosis of probable chronic migraine was only possible by using the ICHD2 criteria (11.9% of patients; p < 0.05). The main criterion which was not satisfied for a definitive diagnosis was the duration of the attacks less than 2 h (70% of patients younger than 6 years; p < 0.005). Amitriptyline and topiramate were the most effective drugs (p < 0.05), although no significant difference was found between them (p > 0.05). Conclusion: The ICHD 3 criteria show limitations when applied to children under 6 years of age. The risk of developing MOH increases with age. Although our "real word" study shows that amitriptyline and topiramate are the most effective drugs regardless of the CPH type, the lack of placebo-controlled data and the limited follow-up results did not allow us to conclude about the drug efficacy.
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Affiliation(s)
- Laura Papetti
- Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
| | - Irene Salfa
- Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
| | - Barbara Battan
- Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
| | - Romina Moavero
- Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Cristiano Termine
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
- Child Neuropsychiatry Unit, ASST dei Sette Laghi, Varese, Italy
| | - Beatrice Bartoli
- Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
- Child Neuropsychiatry Unit, ASST dei Sette Laghi, Varese, Italy
| | - Francesca Di Nunzio
- Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
| | - Samuela Tarantino
- Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
| | | | - Federico Vigevano
- Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
| | - Massimiliano Valeriani
- Headache Center, Department of Neuroscience, Bambino Gesù Children Hospital, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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