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Cohen JM, Alvestad S, Suarez EA, Schaffer A, Selmer RM, Havard A, Bateman BT, Cesta CE, Zoega H, Odsbu I, Huybrechts KF, Kjerpeseth LJ, Straub L, Leinonen MK, Bjørk MH, Nørgaard M, Gissler M, Ulrichsen SP, Hernandez-Diaz S, Tomson T, Furu K. Comparative Risk of Major Congenital Malformations With Antiseizure Medication Combinations vs Valproate Monotherapy in Pregnancy. Neurology 2024; 102:e207996. [PMID: 38165339 PMCID: PMC10870741 DOI: 10.1212/wnl.0000000000207996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Valproate should be avoided in pregnancy, but it is the most effective drug for generalized epilepsies. Alternative treatment may require combinations of other drugs. Our objectives were to describe first trimester use of antiseizure medication (ASM) combinations that are relevant alternatives to valproate and determine whether specific combinations were associated with a lower risk of major congenital malformations (MCM) compared with valproate monotherapy. METHODS We conducted a population-based cohort study using linked national registers from Denmark, Finland, Iceland, Norway, and Sweden and administrative health care data from the United States and New South Wales, Australia. We described first trimester use of ASM combinations among pregnant people with epilepsy from 2000 to 2020. We compared the risk of MCM after first trimester exposure to ASM combinations vs valproate monotherapy and low-dose valproate plus lamotrigine or levetiracetam vs high-dose valproate (≥1,000 mg/d). We used log-binomial regression with propensity score weights to calculate adjusted risk ratios (aRRs) and 95% CIs for each dataset. Results were pooled using fixed-effects meta-analysis. RESULTS Among 50,905 pregnancies in people with epilepsy identified from 7.8 million total pregnancies, 788 used lamotrigine and levetiracetam, 291 used lamotrigine and topiramate, 208 used levetiracetam and topiramate, 80 used lamotrigine and zonisamide, and 91 used levetiracetam and zonisamide. After excluding pregnancies with use of other ASMs, known teratogens, or a child diagnosed with MCM of infectious or genetic cause, we compared 587 exposed to lamotrigine-levetiracetam duotherapy and 186 exposed to lamotrigine-topiramate duotherapy with 1959 exposed to valproate monotherapy. Pooled aRRs were 0.41 (95% CI 0.24-0.69) and 1.26 (0.71-2.23), respectively. Duotherapy combinations containing low-dose valproate were infrequent, and comparisons with high-dose valproate monotherapy were inconclusive but suggested a lower risk for combination therapy. Other combinations were too rare for comparative safety analyses. DISCUSSION Lamotrigine-levetiracetam duotherapy in first trimester was associated with a 60% lower risk of MCM than valproate monotherapy, while lamotrigine-topiramate was not associated with a reduced risk. Duotherapy with lamotrigine and levetiracetam may be favored to treat epilepsy in people with childbearing potential compared with valproate regarding MCM, but whether this combination is as effective as valproate remains to be determined. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in people with epilepsy treated in the first trimester of pregnancy, the risk of major congenital malformations is lower with lamotrigine-levetiracetam duotherapy than with valproate alone, but similar with lamotrigine-topiramate.
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Affiliation(s)
- Jacqueline M Cohen
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Silje Alvestad
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth A Suarez
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Andrea Schaffer
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Randi M Selmer
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Alys Havard
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Brian T Bateman
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Carolyn E Cesta
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Helga Zoega
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Ingvild Odsbu
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Krista F Huybrechts
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Lars J Kjerpeseth
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Loreen Straub
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Maarit K Leinonen
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Marte-Helene Bjørk
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Mette Nørgaard
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Sinna P Ulrichsen
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Sonia Hernandez-Diaz
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Tomson
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
| | - Kari Furu
- From the Department of Chronic Diseases (J.M.C., R.M.S., I.O., L.J.K., K.F.) and Centre for Fertility and Health (J.M.C., K.F.), Norwegian Institute of Public Health, Oslo; Department of Clinical Medicine (S.A., M.-H.B.), University of Bergen, Norway; National Center for Epilepsy (S.A.), Oslo University Hospital, Norway; Division of Pharmacoepidemiology and Pharmacoeconomics (E.A.S., B.T.B., K.F.H., L.S.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Center for Pharmacoepidemiology and Treatment Science (E.A.S.), Rutgers Institute of Health, Health Care Policy and Aging Research & Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; School of Population Health (A.S., A.H., H.Z.) and National Drug and Alcohol Research Centre (A.H.), Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Bennett Institute for Applied Data Science (A.S.), Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; Department of Anesthesiology, Perioperative, and Pain Medicine (B.T.B.), Stanford University, Stanford, CA; Centre for Pharmacoepidemiology (C.E.C., I.O.), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences (H.Z.), Faculty of Medicine, University of Iceland, Reykjavik; Department of Knowledge Brokers (M.K.L., M.G.), Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Neurology (M.-H.B.), Haukeland University Hospital, Bergen, Norway; Department of Clinical Epidemiology (M.N., S.P.U.), Aarhus University Hospital and Aarhus University, Denmark; Research Centre for Child Psychiatry (M.G.), University of Turku, Finland; Region Stockholm (M.G.), Academic Primary Health Care Centre, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology (S.H.-D.), Harvard T.H. Chan School of Public Health, Boston, MA; and Department of Clinical Neuroscience (T.T.), Karolinska Institutet, Stockholm, Sweden
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16
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Oskoui M, Pringsheim T, Billinghurst L, Potrebic S, Gersz EM, Gloss D, Holler-Managan Y, Leininger E, Licking N, Mack K, Powers SW, Sowell M, Victorio MC, Yonker M, Zanitsch H, Hershey AD. Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2019; 93:500-509. [PMID: 31413170 DOI: 10.1212/wnl.0000000000008105] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/14/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To provide updated evidence-based recommendations for migraine prevention using pharmacologic treatment with or without cognitive behavioral therapy in the pediatric population. METHODS The authors systematically reviewed literature from January 2003 to August 2017 and developed practice recommendations using the American Academy of Neurology 2011 process, as amended. RESULTS Fifteen Class I-III studies on migraine prevention in children and adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine, or flunarizine are more or less likely than those receiving placebo to have a reduction in headache frequency. Children with migraine receiving propranolol are possibly more likely than those receiving placebo to have an at least 50% reduction in headache frequency. Children and adolescents receiving topiramate and cinnarizine are probably more likely than those receiving placebo to have a decrease in headache frequency. Children with migraine receiving amitriptyline plus cognitive behavioral therapy are more likely than those receiving amitriptyline plus headache education to have a reduction in headache frequency. RECOMMENDATIONS The majority of randomized controlled trials studying the efficacy of preventive medications for pediatric migraine fail to demonstrate superiority to placebo. Recommendations for the prevention of migraine in children include counseling on lifestyle and behavioral factors that influence headache frequency and assessment and management of comorbid disorders associated with headache persistence. 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.
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Affiliation(s)
- Maryam Oskoui
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Tamara Pringsheim
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Lori Billinghurst
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Sonja Potrebic
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Elaine M Gersz
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - David Gloss
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Yolanda Holler-Managan
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Emily Leininger
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Nicole Licking
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Kenneth Mack
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Scott W Powers
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Michael Sowell
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - M Cristina Victorio
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Marcy Yonker
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Heather Zanitsch
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
| | - Andrew D Hershey
- From the Departments of Pediatrics and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Departments of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences (T.P.), Cumming School of Medicine, University of Calgary, Canada; Division of Neurology (L.B.), Children's Hospital of Philadelphia, PA; Neurology Department (S.P.), Southern California Permanente Medical Group, Kaiser Los Angeles; Rochester (E.M.G.), NY; Department of Neurology (D.G.), Charleston Area Medical Center, Charleston, WV; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; St. Paul (E.L.), MN; Department of Neuroscience and Spine (N.L.), St. Anthony Hospital-Centura Health, Lakewood, CO; Department of Neurology (K.M.), Mayo Clinic, Rochester, MN; Division of Behavioral Medicine & Clinical Psychology (S.W.P., A.D.H.), Cincinnati Children's Hospital Medical Center, OH; University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program (M.S.), KY; Division of Neurology (M.C.V.), NeuroDevelopmental Science Center, Akron Children's Hospital, OH; Division of Neurology (M.Y.), Children's Hospital Colorado, Aurora; and O'Fallon (H.Z.), MO
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