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Seulami N, Gobeil Odai K, Alhefeiti S, Almehairi N, Alzaabi A, Gangatharan H, Wang JJ. Additive Value of Intranasal Fentanyl on Ibuprofen for Pain Management of Children with Moderate to Severe Headaches: A Randomized Controlled Trial. J Emerg Med 2024; 66:258-259. [PMID: 38432706 DOI: 10.1016/j.jemermed.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 03/05/2024]
Affiliation(s)
- Nour Seulami
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | | | | | - Josh J Wang
- McGill University Health Centre, Montreal, Quebec, Canada; McGill University, Montreal, Quebec, Canada
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2
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Synowiec A, Stark-Inbar A, Weinstein M, Ironi A, Mauskop A. One-Year Consistent Safety, Utilization, and Efficacy Assessment of Remote Electrical Neuromodulation (REN) for Migraine Treatment. Adv Ther 2024; 41:170-181. [PMID: 37855973 PMCID: PMC10796417 DOI: 10.1007/s12325-023-02697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Migraine is a chronic neurological disorder causing severe pain and disability in more than a billion people worldwide. Ideal treatment should provide long-term efficacy with minimal side effects. Previous studies indicate that remote electrical neuromodulation (REN) is an efficacious and safe treatment option for the acute treatment of migraine in clinical practice. This study examined long-term safety, utilization, and efficacy of REN during 12 consecutive usage months. METHODS Data from patients with migraine across the USA using REN to treat their migraine attacks were electronically collected from the Nerivio® device. All patients who used REN during 12 consecutive months were included, and data were compared across months. Safety was assessed by the number and type of adverse events. Utilization was measured by the number of monthly treatments. Efficacy was evaluated as consistent change in headache pain intensity, functional disability, and disappearance of associated symptoms from baseline to 2 h post treatment. RESULTS Data were analyzed from 409 people living with migraine who treated with REN for 12 consecutive months, performing a total of 39,531 treatments. The incidence of device-related adverse events (dAEs) was 1.96% (8/409), including two negligible (0.49%), five mild (1.22%), one moderate (0.24%), and no severe events. All patients continued treatment with REN despite dAEs. One-year average monthly utilization was 8.05 treatments (SD 1.15). Month-to-month utilization did not change during 12 months of consecutive use [F(4.895, 1997.204) = 2.014, p = 0.075, repeated-measures ANOVA]. One-year average efficacy showed 74.1% of users reported consistent 2-h pain relief, and 26.0% reported consistent pain freedom. Month-to-month pain relief and pain freedom did not change during 12 months of consecutive use [F(11, 1069) = 0.55, p = 0.873 and F(11, 1295) = 0.69, p = 0.750 respectively; generalized linear mixed model analysis]. CONCLUSION REN is a safe and well-tolerated acute migraine treatment, with stable efficacy and utilization over 1 year, making it an advantageous non-drug option for the long-term management of this chronic disease. TRIAL REGISTRATION NUMBER NCT05760638.
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Affiliation(s)
| | | | | | - Alon Ironi
- Theranica Bio-Electronics, Netanya, Israel
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Chanchlani R, Agrawal A, Janjua D, Hafsa SN. The Efficacy of Different Triptans for the Treatment of Acute Headache in Pediatric Migraine: A Systematic Review. Indian Pediatr 2023; 60:663-671. [PMID: 37209053 DOI: 10.1007/s13312-023-2968-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
BACKGROUND Serotonin receptors 5-HT1B and 5-HT1D in the cerebral arteries are activated by the 5-hydroxytryptophan agonists (triptans) to relieve the discomfort associated with migraines. Even though triptans are often used to treat acute migraines, there is some debate over their effectiveness. OBJECTIVE Our systematic review aimed to evaluate the effectiveness of triptans for acute treatment of migraine in young individuals. METHODS Utilizing the databases of Google Scholar, Cochrane Library, and PubMed, a literature search was conducted, and all papers published till July 2022 were included. This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. In addition to the Boolean operators AND, OR, and NOT, the following descriptive terms were also used: "Triptans," "Pediatric Migraine," "Migraine disorders," "Headache," "Children," and "Adolescent." RESULTS A total of 1047 studies were identified, and 25 articles were finally included in the study. 17 of them were RCTs while the remaining were non-randomized trials. Most studies recruited participants aged between 12-17 years. Among 25 studies, 7 reported sumatriptan use, 3 assessed a combination of sumatriptan and naproxen, 4 were on almotriptan, 1 on eletriptan, 6 on rizatriptan, and 4 on zolmitriptan use. CONCLUSION We found that rizatriptan (good tolerability profile with a dose of 5 mg) and sumatriptan (nasal spray, 10 mg and 20 mg) had higher efficiency as compared to other triptans. Regardless of type or dose, all triptans are generally well tolerated by patients, but a few adverse effects such as light-headedness (sumatriptan), nasopharyngitis, and, muscular spasms (sumatriptan/ naproxen), somnolence, and dry mouth (rizatriptan), and dizziness (zolmitriptan group) were reported with the triptans.
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Affiliation(s)
- Roshan Chanchlani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
| | - Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh. Correspondence to: Dr Amit Agrawal, 28, Ravidas Nagar, Near Nizamuddin Colony, Bhopal, Madhya Pradesh 462 023.
| | - Dalwinder Janjua
- Department of Neonatology, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Shaik Nida Hafsa
- Department of Otorhinolaryngology, Rajiv Gandhi University of Health Sciences, Karnataka, India
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Boutin A, Gouin S, Bailey B, Lebel D, Gravel J. Additive Value of Intranasal Fentanyl on Ibuprofen for Pain Management of Children With Moderate to Severe Headaches: A Randomized Controlled Trial. J Emerg Med 2023; 65:e119-e131. [PMID: 37474344 DOI: 10.1016/j.jemermed.2023.04.023] [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: 12/30/2022] [Revised: 03/20/2023] [Accepted: 04/19/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Few studies have evaluated the rapid pain improvement provided by medications for children presenting to an emergency department (ED) with headaches. OBJECTIVE Our aim was to evaluate pain reduction provided by intranasal fentanyl (INF) compared with placebo in addition to ibuprofen. METHODS A single-center, double-blinded, randomized, placebo-controlled clinical trial was conducted in a tertiary care pediatric ED. All children aged 8-17 years presenting with a moderate to severe headache were eligible. Study participants were randomly allocated to receive INF 1.5 µg/kg (maximum dose of 100 µg) or similar placebo solution. Co-administration of oral ibuprofen 10 mg/kg (maximum dose of 600 mg) was also provided. The primary outcome was the mean pain rating reduction at 15 min. RESULTS Among the 62 participants, the median age was 14 years (interquartile range [IQR] 12-16 years in both groups) and the median initial visual analog scale (VAS) score was 64 (IQR 55-72 in the intervention group; IQR 50-81 in the control group). There was no difference in the mean pain score reduction at 15 min between the two groups (mean difference 2 mm; 95% CI -7 to 11 mm). Mean VAS score reductions were also similar at 30 and 60 min. Adverse events were more frequent in the INF group (risk ratio 2.8; 95% CI 1.29 to 6.22), but all events were minor and transient. No significant differences were found in other outcomes. CONCLUSIONS This study did not find a benefit from INF for providing additional pain relief in children presenting to ED with headaches.
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Affiliation(s)
- Ariane Boutin
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada.
| | - Serge Gouin
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Benoit Bailey
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Lebel
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Battista S, Lazzaretti A, Coppola I, Falsiroli Maistrello L, Rania N, Testa M. Living with migraine: A meta-synthesis of qualitative studies. Front Psychol 2023; 14:1129926. [PMID: 37057143 PMCID: PMC10086165 DOI: 10.3389/fpsyg.2023.1129926] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionMigraine is one of the top ten causes of disability worldwide. However, migraine is still underrated in society, and the quality of care for this disease is scant. Qualitative research allows for giving voice to people and understanding the impact of their disease through their experience of it. This study aims at synthesising the state of the art of qualitative studies focused on how people with migraine experience their life and pathology.MethodsMEDLINE via PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library were consulted up to November 2021 for qualitative studies. Studies to be eligible had to focus on adults (age > 18 years) with a diagnosis of primary episodic or chronic migraine following the International Classification of Headache. The quality of the study was analysed using the CASP (Critical Appraisal Skills Programme) tool. The synthesis was done through a thematic analysis. CERQual (Confidence in Evidence from Reviews of Qualitative research) approach was used to assess the confidence in retrieved evidence.ResultsTen studies were included, counting 262 people with migraine. Our synthesis produced four main themes. (1) “Negative impact of migraine symptoms on overall life” as migraine negatively impacts people's whole life. (2) “Impact of migraine on family, work and social relationship” as migraine reduces the possibility to focus at work and interact with people. (3) “Impact of migraine on emotional health” as people with migraine experience psychological distress. (4) “Coping strategies to deal with migraine” such as keep on living one's own life, no matter the symptoms.ConclusionsMigraine negatively impacts people's whole life, from private to social and work sphere. People with migraine feel stigmatised as others struggle with understanding their condition. Hence, it is necessary to improve awareness among society of this disabling condition, and the quality of care of these people, tackling this disease from a social and health-policy point of view.
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Affiliation(s)
- Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Arianna Lazzaretti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
| | - Ilaria Coppola
- Department of Education Sciences, School of Social Sciences, University of Genova, Genova, Italy
| | - Luca Falsiroli Maistrello
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- Department of Physical Medicine and Rehabilitation, AULSS9 Scaligera, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Nadia Rania
- Department of Education Sciences, School of Social Sciences, University of Genova, Genova, Italy
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- *Correspondence: Marco Testa
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Baumann-Larsen M, Dyb G, Wentzel-Larsen T, Zwart JA, Storheim K, Stensland SØ. Exposure to traumatic events and use of over-the-counter analgesics in adolescents: cross-sectional findings from the Young-HUNT study. BMJ Open 2023; 13:e066058. [PMID: 36931675 PMCID: PMC10030485 DOI: 10.1136/bmjopen-2022-066058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE Frequent and increasing use of over-the-counter analgesics (OTCA) among adolescents is a public health concern. Prior research indicates that adolescents exposed to traumatic events may be at increased risk of suffering from headaches and musculoskeletal pain. In this study, we assessed the association between trauma exposure and use of OTCA for headaches and musculoskeletal pain. DESIGN A cross-sectional population study among adolescents, self-reported data on trauma exposure, pain and use of OTCA. SETTING AND PARTICIPANTS All 10 608 adolescents aged 13-19 years in a region of Norway were invited in this school-based survey, participation rate was 76%. OUTCOME MEASURE Frequency of OTCA use for headache and musculoskeletal pain served as separate outcomes in ordinal logistic regression analyses. RESULTS Trauma exposure was significantly and consistently related to higher frequency use of OTCA for headache and musculoskeletal pain, of which associations for bullying (OR 1.79, 95% CI 1.50 to 2.12, and OR 2.12, 95% CI 1.70 to 2.66), physical violence (OR 1.49, 95% CI 1.25 to 1.78 and OR 1.83, 95% CI 1.45 to 2.32) and sexual abuse (OR 1.83, 95% CI 1.55 to 2.18 and OR 1.53, 95% CI 1.18 to 1.90) were particularly strong. A dose-response relationship was found between interpersonal violence and OTCA use for headache (OR 1.46, 95% CI 1.29 to 1.66 for one type and OR 1.81, 95% CI 1.53 to 2.14 for two or more types) and musculoskeletal pain (OR 1.61, 95% CI 1.91 to 3.00 for one type and OR 2.39, 95% CI 1.91 to 3.00 for two or more types). The associations remained significant after adjustment for pain, although an attenuation in strength was observed. CONCLUSION Trauma exposed adolescents use OTCA for headaches and musculoskeletal pain more frequently than those not exposed. The higher frequency of pain conditions among trauma exposed only partially explained their more frequent OTCA use, indicating an increased risk relating to features beyond frequency of pain.
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Affiliation(s)
- Monica Baumann-Larsen
- Department of Research and Innovation, Oslo University Hospital Division of Clinical Neuroscience, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Grete Dyb
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
- Section for Trauma, catastrophes and forced migration - children and youths, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Tore Wentzel-Larsen
- Section for Trauma, catastrophes and forced migration - children and youths, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway, Oslo, Norway
| | - John-Anker Zwart
- Department of Research and Innovation, Oslo University Hospital Division of Clinical Neuroscience, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | - Kjersti Storheim
- Department of Research and Innovation, Oslo University Hospital Division of Clinical Neuroscience, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Synne Øien Stensland
- Department of Research and Innovation, Oslo University Hospital Division of Clinical Neuroscience, Oslo, Norway
- Section for Trauma, catastrophes and forced migration - children and youths, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Ferderber ML, Rizk C, Zsoldos S, Meardon S, Lin CC. Concussion Recovery in Children and Adolescents: A Retrospective Study. Orthop J Sports Med 2022; 10:23259671221143486. [PMID: 36582929 PMCID: PMC9793036 DOI: 10.1177/23259671221143486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background Concussion is a common injury among children and adolescents, with a growing body of literature supporting a variety of diagnostic and treatment modalities. Recovery is variable and depends on multiple factors that can be evaluated through a clinic visit: a thorough history, physical examination, and use of the Post-concussion Symptom Scale (PCSS). Purpose/Hypothesis The purpose of this study was to evaluate factors associated with overall recovery from concussion in children and adolescents in the clinical setting. It was hypothesized that the presence of 1 of a number of pre- or postinjury characteristics will be associated with poor concussion recovery. Study Design Case-control study; Level of evidence, 3. Methods We conducted a retrospective chart review of adolescents and children aged 6 to 17 years with a diagnosis of concussion who were evaluated at a single sports medicine center between January 2015 and December 2019. Cases were categorized into recovered (PCSS <7) and poorly recovered (PCSS ≥7) cohorts based on the last PCSS scores during clinical follow-ups for concussion management. Results Of the 162 charts reviewed, 110 cases met inclusion criteria. Significant statistical differences were found between the recovered and poorly recovered cohorts regarding mean days from injury to last clinic visit, previous migraine diagnosis, and emergency room (ER) visit before the first clinic visit (P < .01 for all). Binary logistic regression analysis revealed that the most predictive factors associated with poorer recovery were having an ER visit before the first clinic evaluation (P = .01) and previous migraine diagnosis (P = .04). Conclusion While many factors may contribute to overall recovery from concussion in pediatric populations, our study suggested that a history of migraine and an ER visit before clinic evaluation may be associated with poor recovery of concussive symptoms.
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Affiliation(s)
- Megan Lynn Ferderber
- Department of Family Medicine, Brody School of Medicine, East
Carolina University, Greenville, North Carolina, USA.,Megan Lynn Ferderber, MD, MPH, Department of Family Medicine,
Brody School of Medicine, East Carolina University, 101 Heart Dr, Greenville, NC
27834, USA ()
| | - Christina Rizk
- Department of Family Medicine, Brody School of Medicine, East
Carolina University, Greenville, North Carolina, USA
| | - Shellie Zsoldos
- Department of Physical Therapy, College of Allied Health Sciences,
East Carolina University, Greenville, North Carolina, USA
| | - Stacey Meardon
- Department of Physical Therapy, College of Allied Health Sciences,
East Carolina University, Greenville, North Carolina, USA
| | - Chia-Cheng Lin
- Department of Physical Therapy, College of Allied Health Sciences,
East Carolina University, Greenville, North Carolina, USA
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8
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Bonfert MV, Sollmann N, Renner T, Börner C, Urban G, Schandelmaier P, Hannibal I, Huß K, Parisi C, Gerstl L, Vill K, Blaschek A, Koenig H, Klose B, Heinen F, Landgraf MN, Albers L. Burden of disease and lifestyle habits in adolescents and young adults prone
to frequent episodic migraine: A secondary comparative analysis. J Child Health Care 2022; 26:215-227. [PMID: 33955272 PMCID: PMC9194962 DOI: 10.1177/13674935211008712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to assess the burden of disease and prevalence of lifestyle factors for adolescents and young adults with frequent episodic migraine. We conducted a secondary comparative analysis of data collected during two previous studies. Inclusion criteria for this analysis were age 15-35 years, 15 to 44 migraine episodes within 12 weeks, and completeness of Migraine Disability Assessment and lifestyle questionnaire data. Datasets of 37 adults (median age [interquartile range]: 25 [6]) and 27 adolescents (median age [interquartile range]: 15 [1]) were analyzed. 81% (n = 30) of adults reported severe disability (16% [n = 3] of adolescents; p < 0.001). Headache frequency (24 vs. 17 days; p = 0.005) and prevalence of regular analgesic use (60% [n = 22] vs. 18% [n = 5]; p = 0.002) were significantly higher in adults. In adults, sleep duration on weekdays was significantly lower (8.5 vs. 10 h; p < 0.001). Any consumption of caffeine tended to be higher in adolescents and alcohol consumption tended to be higher in adults (p > 0.05). This study underlines the importance of educating adolescents and young adults with migraine about lifestyle habits that are likely to interfere with the condition.
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Affiliation(s)
- Michaela V Bonfert
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany,Michaela V Bonfert, Department of Pediatric
Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity,
Dr von Hauner Children’s Hospital, LMU Hospital, Lindwurmstraße 4, Munich, Bavaria 80337,
Germany.
| | - Nico Sollmann
- Department of Diagnostic and Interventional
Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany,TUM-Neuroimaging Center, Klinikum Rechts
der Isar, Technical University of Munich, Germany,Department of Diagnostic and Interventional
Radiology, University Hospital Ulm, Germany
| | - Tabea Renner
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Corinna Börner
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Giada Urban
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Paul Schandelmaier
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Iris Hannibal
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Kristina Huß
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Carmen Parisi
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Astrid Blaschek
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Helene Koenig
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Birgit Klose
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Lucia Albers
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany,Department of Neurosurgery, Klinikum Rechts
der Isar, Technical University of Munich, Germany
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Collins-Yoder A, Key B. Acute ischemic stroke or migraine with aura? Triage considerations. Nursing 2022; 52:17-23. [PMID: 35085190 DOI: 10.1097/01.nurse.0000806152.65968.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This article discusses the complex relationship between acute ischemic stroke and migraine with aura, and critical nursing interventions.
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Affiliation(s)
- Angela Collins-Yoder
- Angela Collins-Yoder is a clinical professor at the University of Alabama's Capstone College of Nursing and a critical care clinical nurse specialist at Ascension Sacred Heart. Betty Key is an assistant professor at Samford University in Birmingham, Ala
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Zernikow B, Frosch M, Wager J. 14/w mit rezidivierend auftretenden Kopfschmerzen und massiven Schulfehlzeiten. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-021-01405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Standardized Headache Therapy in the Pediatric Emergency Department Using Improvement Methodology. Pediatr Qual Saf 2021; 6:e443. [PMID: 34345756 PMCID: PMC8322484 DOI: 10.1097/pq9.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Primary headache is a common cause of pediatric emergency department (PED) visits. Without published guidelines to direct treatment options, various strategies lacking evidence are often employed. This study aims to standardize primary headache treatment in the PED by promoting evidence-based therapies, reducing nonstandard abortive therapies, and introducing dihydroergotamine (DHE) into practice. Methods: A multidisciplinary team developed key drivers, created a clinical care algorithm, and updated electronic medical record order sets. Outcome measures included the percentage of patients receiving evidence-based therapies, nonstandard abortive therapies, DHE given after failed first-line therapies, and overall PED length of stay. Process measures included the percent of eligible patients with the order set usage and medications received within 90 minutes. Balancing measures included hospital admissions and returns to the PED within 72 hours. Annotated control charts depicted results over time. Results: We collected data from July 2017 to December 2019. The percent of patients receiving evidence-based therapies increased from 69% to 73%. The percent of patients receiving nonstandard abortive therapies decreased from 2.5% to 0.6%. The percent of patients receiving DHE after failed first-line therapies increased from 0% to 37.2%. No untoward effects on process or balancing measures occurred, with sustained improvement for 14 months. Conclusion: Standardization efforts for patients with primary headaches led to improved use of evidence-based therapies and reduced nonstandard abortive therapies. This methodology also led to improved DHE use for migraine headache resistant to first-line therapies. We accomplished these results without increasing length of stay, admission, or return visits.
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12
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Lambrinakos-Raymond K, Dubrovsky AS, Gagnon I, Zemek R, Burstein B. Management of Pediatric Post-Concussion Headaches: National Survey of Abortive Therapies Used in the Emergency Department. J Neurotrauma 2021; 39:144-150. [PMID: 33787343 DOI: 10.1089/neu.2020.7508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Children frequently present to an Emergency Department (ED) after concussion, and headache is the most commonly associated symptom. Recent guidelines emphasize the importance of analgesia for post-concussion headache (PCH), yet evidence to inform treatment is lacking. We sought to characterize abortive therapies used to manage refractory PCH in the pediatric ED and factors associated with treatment. A scenario-based survey was distributed to ED physicians at all 15 Canadian tertiary pediatric centers. Participants were asked questions regarding ED treatment of acute (48 h) and persistent (1 month) PCH refractory to appropriate doses of acetaminophen/ibuprofen. Logistic regression was used to assess factors associated with treatment. Response rate was 63% (137/219). Nearly all physicians (128/137, 93%) endorsed treatment in the ED for acute PCH of severe intensity, with most selecting intravenous treatments (116/137, 84.7%). Treatments were similar for acute and persistent PCH. The most common treatments were metoclopramide (72%), physiologic saline (47%), and nonsteroidal anti-inflammatory agents (NSAIDS; 35%). Second-line ED treatments were more variable. For acute PCH of moderate intensity, overall treatment was lower (102/137, 74%; p < 0.0001), and NSAIDS (48%) were most frequently selected. In multi-variable regression analyses, no physician- or ED-level factor was associated with receiving treatment, or treatment using metoclopramide specifically. Treatment for refractory PCH in the pediatric ED is highly variable. Importantly, patients with severe PCH are most likely to receive intravenous therapies, often with metoclopramide, despite a paucity of evidence supporting these choices. Further research is urgently needed to establish the comparative effectiveness of pharmacotherapeutic treatments for children with refractory PCH.
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Affiliation(s)
- Kristen Lambrinakos-Raymond
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.,UP Centre for Pediatric Emergencies, Brossard, Quebec, Canada
| | - Alexander Sasha Dubrovsky
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.,UP Centre for Pediatric Emergencies, Brossard, Quebec, Canada
| | - Isabelle Gagnon
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine and Research Institute, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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VanderPluym J, Gautreaux J, Burch R, Whitaker E, Roberts J, Turner DP, Gelfand AA. Evidence Regarding Medication Overuse Headache in Children and Adolescents: Protocol for a Systematic Review. Headache 2021; 60:171-177. [PMID: 31913513 DOI: 10.1111/head.13726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This proposed systematic review will identify the existing evidence on medication-overuse headache in children and adolescents. BACKGROUND A number of medications have been shown to be effective for acute treatment of migraine in children and adolescents. However, patients may find they need to use their acute medications more frequently when migraine frequency is high. This has led to concern about their potential to develop medication-overuse headache. METHODS We will search PubMed, Embase, Web of Science, PsycINFO, and Cochrane databases from their inception to present time. We will also search conference proceedings of the last 4 scientific meetings of relevant societies and scan the reference lists of studies identified through the search. Study designs will include case series, cross-sectional, cohort, case-control, and interventional studies. Participants will include children and adolescents under 18 years of age with primary headache disorders. We aim to determine whether frequency of acute medication use is associated with headache frequency in children and adolescents. Outcomes of interest include: (1) headache frequency; (2) change in headache frequency, with time and in relationship to use of acute medications; and (3) headache-related disability. We will also review data addressing treatment/management of medication overuse or medication-overuse headache in children and adolescents. Relevant comparators will be withdrawal vs reduction of acute medication, initiation of preventive therapy vs no initiation with or without withdrawal of acute medication, and initiation of preventive therapy early vs late. Outcomes of interest include (1) days of acute medication use; (2) headache frequency; (3) change in headache frequency; and (4) headache-related disability. After screening for inclusion, 2 team members will independently review and extract relevant data, and any discrepancies will be resolved through discussion and arbitration. We will assess risk of bias using appropriate tools (Cochrane Risk of Bias for randomized controlled trials (RCT) and Newcastle-Ottawa Score for observational studies). Data will be summarized descriptively in text and tables. RESULTS This systematic review will provide an overview of the available evidence on medication-overuse headache in children and adolescents. CONCLUSIONS Findings from this review will aid clinicians by clarifying for them the current state of the evidence base, and will inform design of future research on this topic.
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Affiliation(s)
| | - Jessica Gautreaux
- Department of Neurology, Children's Hospital of New Orleans, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Rebecca Burch
- Brigham and Women's Hospital Department of Neurology, Graham Headache Center, Harvard Medical School, Boston, MA, USA
| | - Evans Whitaker
- Library Studies, University of California San Francisco, San Francisco, CA, USA
| | - Jason Roberts
- Headache Journal, Headache Editorial Office, Plymouth, MA, USA
| | - Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy A Gelfand
- Child & Adolescent Headache Program, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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Orr SL, Powers SW. Virtual issue: Kids (with headache disorders) are not just little adults (with headache disorders). Headache 2021; 61:563-564. [PMID: 33891345 DOI: 10.1111/head.14090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Serena L Orr
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Section of Neurology, Alberta Children's Hospital, Calgary, AB, Canada
| | - Scott W Powers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Szperka CL, VanderPluym JH, Oakley CB. Pharmacologic Acute and Preventive Treatment for Migraine in Children and Adolescents. JAMA Neurol 2021; 77:388-389. [PMID: 31816037 DOI: 10.1001/jamaneurol.2019.4170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Christina L Szperka
- Children's Hospital of Philadelphia, Perelman School of Medicine, Division of Neurology, Departments of Neurology and Pediatrics, University of Pennsylvania, Philadelphia
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Singh S, Chakrabarty B. Acetaminophen or Ibuprofen: A Riddle Worth Solving in an Acute Attack of Pediatric Migraine. Indian J Pediatr 2020; 87:775-776. [PMID: 32857330 DOI: 10.1007/s12098-020-03479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sonali Singh
- Child Neurology Division, Department of Pediatrics, AIIMS, New Delhi, India
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Lu T, Lu C, Li H, Xing X, Deng X, Li X, Wang Y, Niu J, Liu Y, Yang K. The reporting quality and risk of bias of randomized controlled trials of acupuncture for migraine: Methodological study based on STRICTA and RoB 2.0. Complement Ther Med 2020; 52:102433. [PMID: 32951707 DOI: 10.1016/j.ctim.2020.102433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To investigate the reporting quality and risk of bias of randomized controlled trials (RCTs) of acupuncture for migraine, to facilitate and improve the quality of RCTs of acupuncture for migraine. METHODS The Cochrane Library, PubMed and EMBASE were searched from inception to June 11, 2019 using a comprehensive search strategy. The reporting quality and risk of bias of included RCTs were independently evaluated by two investigators using STRICTA and RoB 2.0. Any disagreement was resolved by a third investigator. RESULTS A total of 28 eligible RCTs were published in 24 academic journals from 1994 to 2018. Based on STRICTA, four sub-items including "details of other interventions'' (1/28, 4 %), "setting and context of treatment" (9/28, 32 %), "the extent to which treatment was varied" (11/28, 39 %), and "number of needle insertions per subject per session" (13/28, 46 %), showed low reporting quality. A total of 32 different outcomes were reported in 28 RCTs, and based on RoB 2.0, nine (9/28, 32 %) RCTs were judged to be high RoB, three of which were owing to deviations from intended interventions; 11(11/28, 39 %) RCTs elicited some concerns; and eight (8/28, 29 %) RCTs were low RoB for their outcomes. CONCLUSIONS The reporting quality and risk of bias of RCTs of acupuncture for migraine remain suboptimal. Therefore, all stakeholders should make a contribution to improve the quality of RCTs of acupuncture for migraine using STRICTA and RoB 2.0, while not limiting this approach solely to studies on migraine, using STRICTA and RoB 2.0 tools.
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Affiliation(s)
- Tingting Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Cuncun Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Huijuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xin Xing
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Xiuxiu Deng
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiuxia Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Yongfeng Wang
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Junqiang Niu
- First Hospital of Lanzhou University, Lanzhou, China
| | - Yali Liu
- Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
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18
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Gelfand AA, Ross AC, Irwin SL, Greene KA, Qubty WF, Allen IE. Melatonin for Acute Treatment of Migraine in Children and Adolescents: A Pilot Randomized Trial. Headache 2020; 60:1712-1721. [DOI: 10.1111/head.13934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Amy A. Gelfand
- Department of Neurology UCSF Child & Adolescent Headache Program San Francisco CA USA
| | - Alexandra C. Ross
- Department of Pediatrics UCSF Child & Adolescent Headache Program San Francisco CA USA
| | - Samantha L. Irwin
- Department of Neurology UCSF Child & Adolescent Headache Program San Francisco CA USA
| | - Kaitlin A. Greene
- Division of Pediatric Neurology Department of Pediatrics Oregon Health & Science University Portland OR USA
| | - William F. Qubty
- Pediatric Headache Program Dell Medical School University of Texas at Austin Austin TX USA
| | - I. Elaine Allen
- Department of Epidemiology & Biostatistics University of California San Francisco San Francisco CA USA
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19
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Yamanaka G, Go S, Morichi S, Takeshita M, Morishita N, Suzuki S, Tomoko T, Kasuga A, Daida A, Ishida Y, Oana S, Suganami Y, Nagao R, Kashiwagi Y, Kawashima H. Clinical Features and Burden Scores in Japanese Pediatric Migraines With Brainstem Aura, Hemiplegic Migraine, and Retinal Migraine. J Child Neurol 2020; 35:667-673. [PMID: 32476572 DOI: 10.1177/0883073820927840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Migraines are a broad spectrum of disorders classified by the type of aura with some requiring attentive treatment. Vasoconstrictors, including triptans, should be avoided in the acute phase of migraines with brainstem aura, in hemiplegic migraine, and in retinal migraine. This study investigated the characteristics and burden of these migraines. METHODS Medical charts of 278 Japanese pediatric patients with migraines were retrospectively reviewed. Migraine burden of migraines with brainstem aura, hemiplegic migraines, and retinal migraine was assessed using the Headache Impact Test-6™ (HIT-6) and the Pediatric Migraine Disability Assessment scale (PedMIDAS). RESULTS Of 278 patients screened, 12 (4.3%) patients with migraines with brainstem aura (n = 5), hemiplegic migraines (n = 2), and retinal migraine (n = 5) were enrolled in the study. All patients had migraine with/without typical aura, whereas some patients had coexisting migraine with another type of headache (chronic tension-type headache in 3 patients, and 1 each with frequent episodic tension-type headache, headache owing to medication overuse, and chronic migraine). Migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients with coexisting headaches had higher HIT-6 or PedMIDAS scores, whereas migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients without coexisting headache did not show high HIT-6 or PedMIDAS scores. CONCLUSION All migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients experienced migraine with or without typical aura, and some patients having other coexisting headaches also had high PedMIDAS and HIT-6 scores. PedMIDAS and HIT-6 should not be considered diagnostic indicators of migraines with brainstem aura, hemiplegic migraines, or retinal migraine. In clinical practice for headaches in children, careful history taking and proactive assessment of the aura are needed for accurate diagnosis of migraines with brainstem aura, hemiplegic migraines, and retinal migraine.
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Affiliation(s)
- Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Soken Go
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shinichiro Morichi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Mika Takeshita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Natsumi Morishita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shinji Suzuki
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Takamatsu Tomoko
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Akiko Kasuga
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Atsuro Daida
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yu Ishida
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shingo Oana
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Suganami
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Ryuhei Nagao
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yasuyo Kashiwagi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Kawashima
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
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