1
|
Martin EG, Kuziek J, Rasiah J, Orr SL. Evaluating patient and family preferences for acute and preventive pediatric headache treatment. Headache 2024. [PMID: 38828670 DOI: 10.1111/head.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/07/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE To describe acute and preventive treatment preferences among youth with migraine and their parents/guardians, and to describe the degree of youth-parent/guardian preference agreement. BACKGROUND Headache disorders are common in youth, but little is known about patient and family preferences for headache treatments and outcomes. METHODS In this cross-sectional survey, a headache treatment preferences questionnaire was co-created with stakeholders, piloted, and distributed to consenting youth with migraine aged 9-18 years and parents/guardians at a tertiary care headache clinic in western Canada. Response data were summarized for youth and parents/guardians separately, and agreement rates within a youth-parent/guardian pair were compared to a hypothesized agreement rate of 80% for the primary questionnaire items. RESULTS Seventy-two youth and n = 94 parents/guardians participated, with n = 63 in youth-parent/guardian pairs. Freedom from pain and rapid relief, and reducing pain severity and headache frequency were top acute and preventive treatment priorities, respectively. More than 90% (69/72) agreed that ≥ 50% reduction in headache frequency was a good target. For both acute and preventive interventions, swallowed pill-based options were most often selected as the preferred first-line treatment, with neuromodulation selected as the preferred second-line treatment. The level of agreement within youth-parent/guardian pairs on preferred treatment modalities was lower than hypothesized for acute (63% [40/63], 95% confidence interval [CI] = 52-75%, χ2 = 10.73, p = 0.001) but not for preventive treatment (73% [46/63], 95% CI = 62-84%, χ2 = 1.92, p = 0.166). Regarding which treatment modalities were perceived as most effective, youth-parent agreement was lower than hypothesized for both acute (48% [30/63], 95% CI = 35-60%, χ2 = 41.29, p < 0.001) and preventive treatment (46% [29/63], 95% CI = 34-58%, χ2 = 45.43, p < 0.001). CONCLUSION Youth and family preferences aligned qualitatively, but sometimes diverged quantitatively, from typical clinical trial outcomes. The level of agreement within youth-parent/guardian pairs on treatment preferences and perceptions was low. Clinicians should consider both perspectives as they may be divergent.
Collapse
Affiliation(s)
- Elise G Martin
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Kuziek
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jananee Rasiah
- Alberta Strategy for Patient Oriented Research Support Unit, Patient Engagement Platform, Calgary, Alberta, Canada
- Faculty of Nursing, MacEwan University, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - Serena L Orr
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
2
|
Orr SL. Headache in Children and Adolescents. Continuum (Minneap Minn) 2024; 30:438-472. [PMID: 38568493 DOI: 10.1212/con.0000000000001414] [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: 04/05/2024]
Abstract
OBJECTIVE This article reviews the assessment of children and adolescents presenting with headache, provides an overview of primary headache disorders, and reviews evidence-based management of headache in this age group. LATEST DEVELOPMENTS In the last few years, new epidemiological data have shed light on less common pediatric headache disorders (eg, pediatric trigeminal autonomic cephalalgias) and psychosocial risk factors associated with primary headache disorders in children and adolescents. There has also recently been a substantial increase in interventions that target the calcitonin gene-related peptide pathway and that treat primary headache disorders using noninvasive neuromodulation. Although these interventions have primarily been studied in adults, there is emerging evidence of their use in the pediatric population. ESSENTIAL POINTS Primary headache disorders are very common in youth, and the most commonly encountered headache diagnosis in neurology practice is migraine, which affects approximately 10% of children and adolescents. Diagnosing and effectively treating primary headache disorders before adulthood may have a sustained impact on the patient by improving long-term headache and mental health outcomes, thereby significantly reducing the burden of disability over time. There are several available and emerging acute and preventive interventions for youth with primary headache disorders, and treatment decisions should be made in the context of available evidence using a shared decision-making approach.
Collapse
|
3
|
Rizvi BA, Kuziek J, Cho LY, Ronksley PE, Noel MN, Orr SL. Anxiety and depressive symptoms and migraine-related outcomes in children and adolescents. Headache 2024; 64:342-351. [PMID: 38581204 DOI: 10.1111/head.14701] [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: 10/19/2023] [Revised: 02/02/2024] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE The objective of this study was to explore the longitudinal relationship between anxiety and depressive symptoms and migraine outcomes in children and adolescents. BACKGROUND Children and adolescents with migraine experience more anxiety and depressive symptoms than their peers without migraine, but it is unknown if these symptoms are associated with differential migraine outcomes. METHODS In this prospective clinical cohort study, children and adolescents aged 8.0-18.0 years with migraine completed headache questionnaires and validated measures of anxiety and depressive symptoms (Patient-Reported Outcomes Measurement Information System) at an initial consultation and at their first follow-up visit with a neurologist. Changes in monthly headache frequency and changes in migraine-related disability (Pediatric Migraine Disability Assessment) were tracked at each time point. The relationships between these migraine outcomes and anxiety and depressive symptoms were estimated using models controlling for sex, age, headache frequency, and treatment type. RESULTS There were 123 consenting participants. In models adjusted for age, sex, baseline disability score, and treatment type, baseline anxiety and depressive symptom levels were not significantly associated with change in headache frequency (for anxiety symptoms: β = -0.05, 95% confidence interval [CI] = -0.268 to 0.166, p = 0.639; for depressive symptoms: β = 0.14, 95% CI = -0.079 to 0.359, p = 0.209). Similarly, in models adjusted for age, sex, baseline headache frequency, and treatment type, the change in disability was not associated with baseline anxiety (β = -0.45, 95% CI = -1.69 to 0.78, p = 0.470), nor with baseline depressive symptom scores (β = 0.16, 95% CI = -1.07 to 1.40, p = 0.796). In post hoc exploratory analyses (N = 84 with anxiety and N = 82 with depressive symptom data at both visits), there were also no significant associations between change in mental health symptoms and change in headache frequency (for anxiety symptoms: β = -0.084, 95% CI = -0.246 to 0.078, p = 0.306; for depressive symptoms: β = -0.013, 95% CI = -0.164 to 0.138, p = 0.865). Similarly, the change in disability scores between visits was not related to the change in anxiety (β = 0.85, 95% CI = -0.095 to 1.78, p = 0.077) nor depressive symptom scores (β = 0.32, 95% CI = -0.51 to 1.15, p = 0.446). CONCLUSION Baseline anxiety and depressive symptom levels were not associated with longitudinal migraine outcomes and neither were longitudinal changes in anxiety and depressive symptom levels; this contradicts popular clinical belief that mental health symptoms predict or consistently change in tandem with migraine outcomes.
Collapse
Affiliation(s)
- Bilal Ahmed Rizvi
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Kuziek
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lydia Y Cho
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul E Ronksley
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Melanie N Noel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health, University of Calgary, Calgary, Alberta, Canada
| | - Serena Laura Orr
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
4
|
Olfat M, Hosseinpour S, Masoumi S, Gogia Rastogi R, Vance Hastriter E, Lewis KS, Little R, T Karnik K, Hickman C, Heidari M, Shervin Badv R, Mohammadi M, Zamani GR, Mohammadpour M, Ashrafi MR, Tavasoli AR. A comparative study on prophylactic efficacy of cinnarizine and amitriptyline in childhood migraine: a randomized double-blind clinical trial. Cephalalgia 2024; 44:3331024241230963. [PMID: 38641932 DOI: 10.1177/03331024241230963] [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] [Indexed: 04/21/2024]
Abstract
BACKGROUND Pediatric migraine prophylaxis is indicated when headaches are frequent and/or disabling. We aimed to conduct a study to compare the efficacy of cinnarizine and amitriptyline in pediatric migraine prophylaxis. METHODS In a randomized, double-blind trial, patients aged 4-17 years with migraine who were eligible for prophylaxis enrolled. The primary outcome was a reduction response rate of ≥50% with p < 0.005 with respect to headache characteristics. The secondary outcome was migraine disability assessment. We evaluated patients every four weeks for three months: T1: week 4, T2: week 8 and T3: week 12. The safety profile was also assessed. RESULTS Thirty patients were randomly assigned to each group. However, 43 patients completed the trial. Headache frequency decreased in amitriptyline group more effectively in T1 (p = 0.004). Amitriptyline was more successful in reducing the headache duration in all three periods (p < 0.005). There was no significant difference in severity improvement and reducing disability score between the two groups (p > 0.005). No serious adverse events were observed. CONCLUSIONS Both medications are effective in ameliorating migraine headaches and related disabilities. However, amitriptyline appears be a preferable option over cinnarizine, given its faster onset of action, efficacy in reducing headache duration and longer-lasting effects.Trial Registration: The study was registered with the Iranian Registry of Clinical Trials (IRCT) under the code IRCT-20191112045413N1.
Collapse
Affiliation(s)
- Mehrnaz Olfat
- Division of Pediatric Intensive Care, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Hosseinpour
- Department of Neurology, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Safdar Masoumi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak, Tehran, Iran
| | - Reena Gogia Rastogi
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Eric Vance Hastriter
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kara Stuart Lewis
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Robert Little
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Kavitha T Karnik
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Carolyn Hickman
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Morteza Heidari
- Department of Neurology, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Department of Neurology, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Mohammadi
- Department of Neurology, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholam Reza Zamani
- Department of Neurology, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mohammadpour
- Division of Pediatric Intensive Care, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Ashrafi
- Department of Neurology, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Tavasoli
- Department of Neurology, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| |
Collapse
|
5
|
Vesole AS, Bachmann KR, Mueller GA, Lavender VH, Castiglione M, Greinwald JH. The Role of Motion Sensitivity and Headaches on Vestibular Rehabilitation Outcomes in Pediatric Vestibular Migraines. Otol Neurotol 2024; 45:e177-e185. [PMID: 38361298 DOI: 10.1097/mao.0000000000004120] [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: 02/17/2024]
Abstract
OBJECTIVE To determine the utility of the motion sensitivity quotient (MSQ) in diagnosing pediatric vestibular migraine (VM) and to characterize the role of motion sensitivity and headache control on vestibular rehabilitation (VR) outcomes in pediatric VM. STUDY DESIGN Retrospective cohort analysis. SETTING Pediatric tertiary referral center. PATIENTS Children (≤18 years old) with dizziness who completed vestibular testing from January 2016 to August 2022, diagnosed with either VM or another vestibular disorder. INTERVENTIONS VR, which included MSQ testing. MAIN OUTCOME MEASURES Initial MSQ, number and duration of vestibular physical therapy (PT) sessions, PT goals met, and posttreatment MSQ. RESULTS Two hundred fifty-seven patients met study criteria. MSQ was not a reliable diagnostic marker in pediatric VM as there was no difference in initial MSQ between VM and non-VM patients (9.4 vs. 7.8 in non-VM, p = 0.014). Both VM (n = 116) and non-VM (n = 141) patients demonstrated significant improvement in MSQ after VR (p = 0.004). However, VM patients tended to be less likely to meet at least one PT goal (60 vs. 77% in non-VM, p = 0.016, d = 0.37), although not significant. VM patients with more frequent headaches had significantly higher initial MSQ (p = 0.008). VM patients with more frequent headaches or higher initial MSQ tended to require increased number and longer duration of VR (small/medium effect size although not statistically significant after Bonferroni correction). CONCLUSION VR is an effective treatment for both VM and non-VM pediatric patients. VM patients, especially those with severe motion sensitivity or poorly controlled headaches, may be less responsive to VR and may require increased frequency and duration of VR. Our findings propose the importance of counseling pediatric patients with severe motion sensitivity or uncontrolled migraines regarding realistic expectations of their VR course.
Collapse
Affiliation(s)
- Adam S Vesole
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | | | | | | |
Collapse
|
6
|
Magdy R, Hassan A, Mohammed Z, Abdeltwab MA, Ghaffar NFA, Hussein M. Validity and reliability of Arabic version of pediatric migraine disability assessment scale (Child Self-Report versus Parent Proxy-Report): a multi-center study. J Headache Pain 2024; 25:15. [PMID: 38311737 PMCID: PMC10840291 DOI: 10.1186/s10194-024-01713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Pediatric Migraine Disability Assessment (PedMIDAS) is one of the most frequently used questionnaires to assess disability from migraine in pediatric patients. This work aimed to evaluate the validity and test-retest reliability of the Arabic version of the child self-report versus the parent proxy report PedMIDAS. We also aimed to test the agreement between children's and parents' reports of the scale. METHODS PedMIDAS was subjected to translation and back-translation, then applied to 112 pediatric patients fulfilling the migraine diagnostic criteria. This cross-sectional study was conducted on two visits, one week apart. At visit 1, the following data were obtained from the included pediatric patients: disease duration, migraine type, current treatment regimen, monthly migraine days (MMD) during the last month preceding the enrollment, and migraine intensity using the visual analogue scale. Then, each child and his parent were independently asked to fill out PedMIDAS and Child Self-Report of the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™) to test the convergent validity of PedMIDAS. At visit 2, each child was requested to complete PedMIDAS again, and so was the parent to evaluate test-retest reliability. RESULTS Cronbach's alpha was estimated to be 0.94 for each instrument. For the child-self report PedMIDAS, the average measure intraclass correlation coefficient (ICC) value was 0.992 (95%CI = 0.989-0.995), while it was estimated to be 0.990 for the parent-proxy report with 95%CI = 0.985-0.993, indicating excellent test-retest reliability for both instruments. The child-self report and the parent-proxy report PedMIDAS scores were significantly correlated with MMD, VAS, and all domains of the corresponding PedsQL, supporting convergent validity for both instruments. Agreement between parent and child on disability grading categories of PedMIDAS was substantial (κ = 0.644). CONCLUSION The Arabic version of PedMIDAS was a valid and reliable instrument to assess disability from migraine in Arabic-speaking pediatric patients with migraine. Parent reports can be valuable as a complement to child reports for a comprehensive assessment of migraine.
Collapse
Affiliation(s)
- Rehab Magdy
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Amr Hassan
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Zeinab Mohammed
- Department of Public Health and Community Medicine, Public Health and Community Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | | | | - Mona Hussein
- Department of Neurology, Beni-Suef University, Salah Salem Street, Beni-Suef, 62511, Egypt.
| |
Collapse
|
7
|
Fila M, Chojnacki C, Chojnacki J, Blasiak J. The kynurenine pathway of tryptophan metabolism in abdominal migraine in children - A therapeutic potential? Eur J Paediatr Neurol 2024; 48:1-12. [PMID: 37984006 DOI: 10.1016/j.ejpn.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Abdominal migraine (AM) is a clinical diagnosis specified by Rome IV and ICHD III as a functional gastrointestinal disease (FGID) and a migraine associated syndrome, respectively. Abdominal migraine in childhood and adolescence may continue with migraine headaches in adulthood. This disease is undiagnosed and undertreated, and thus far the FDA has not approved any drug for AM treatment. It was shown that changes in the kynurenine (KYN) pathway of tryptophan (TRP) metabolism played an important role in the pathogenesis and treatment of FIGDs and associated mood disorders. Changes in the KYN pathway were shown in migraine and therefore it may be involved in AM pathogenesis. FINDINGS Abdominal migraine reflects an impairment in the communication within the gut-brain axis. Treatment approaches in AM are based on the experience of physicians, presenting personal rather than evidence-based practice, including efficacy of some drugs in adult migraine. Non-pharmacological treatment of AM is aimed at preventing or ameliorating AM triggers and is based on the STRESS mnemonic. Metabolic treatments with riboflavin and coenzyme Q10 were effective in several cases of pediatric migraine, but in general, results on metabolic treatment in migraine in children are scarce and nonconclusive. Modulations within the KYN pathway of TRP metabolism induced by changes in TRP content in the diet, may ameliorate FGIDs and support their pharmacological treatment. Pharmacological manipulations of brain KYNs in animals have brought promising results for clinical applications. Obese children show a higher headache prevalence and may be especially predisposed to AM, and KYN metabolites showed an alternated distribution in obese individuals as compared with their normal-weight counterparts. CONCLUSIONS In conclusion, controlled placebo-based clinical trials with dietary manipulation to adjust the amount of the product of the KYN pathway of TRP metabolism are justified in children and adolescents with AM, especially those with coexisting obesity. Further preclinical studies are needed to establish details of these trials.
Collapse
Affiliation(s)
- Michal Fila
- Department of Developmental Neurology and Epileptology, Polish Mother's Memorial Hospital Research Institute, 93-338, Lodz, Poland
| | - Cezary Chojnacki
- Department of Clinical Nutrition and Gastroenterological Diagnostics, Medical University of Lodz, 90-647, Poland
| | - Jan Chojnacki
- Department of Clinical Nutrition and Gastroenterological Diagnostics, Medical University of Lodz, 90-647, Poland
| | - Janusz Blasiak
- Faculty of Medicine, Collegium Medicum, Mazovian Academy in Plock, 09-420 Plock, Poland.
| |
Collapse
|
8
|
Giza CC, Gioia G, Cook LJ, Asarnow R, Snyder A, Babikian T, Thompson P, Bazarian JJ, Whitlow CT, Miles CM, Otallah S, Kamins J, Didehbani N, Rosenbaum PE, Chrisman SP, Vaughan CG, Cullum M, Popoli DM, Choe M, Gill J, Dennis EL, Donald CLM, Rivara FP. CARE4Kids Study: Endophenotypes of Persistent Post-Concussive Symptoms in Adolescents: Study Rationale and Protocol. J Neurotrauma 2024; 41:171-185. [PMID: 37463061 PMCID: PMC11071085 DOI: 10.1089/neu.2023.0073] [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] [Indexed: 07/20/2023] Open
Abstract
Treatment of youth concussion during the acute phase continues to evolve, and this has led to the emergence of guidelines to direct care. While symptoms after concussion typically resolve in 14-28 days, a portion (∼20%) of adolescents endorse persistent post-concussive symptoms (PPCS) beyond normal resolution. This report outlines a study implemented in response to the National Institute of Neurological Diseases and Stroke call for the development and initial clinical validation of objective biological measures to predict risk of PPCS in adolescents. We describe our plans for recruitment of a Development cohort of 11- to 17-year-old youth with concussion, and collection of autonomic, neurocognitive, biofluid, and imaging biomarkers. The most promising of these measures will then be validated in a separate Validation cohort of youth with concussion, and a final, clinically useful algorithm will be developed and disseminated. Upon completion of this study, we will have generated a battery of measures predictive of high risk for PPCS, which will allow for identification and testing of interventions to prevent PPCS in the most high-risk youth.
Collapse
Affiliation(s)
- Christopher C. Giza
- Department of Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurosurgery, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- UCLA BrainSPORT Program, Los Angeles, California, USA
| | - Gerard Gioia
- Department of Neuropsychology, Children's National Hospital and George Washington University School of Medicine, Washington, DC, USA
| | - Lawrence J. Cook
- Department of Pediatric Critical Care, University of Utah, Salt Lake City, Utah, USA
| | - Robert Asarnow
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Aliyah Snyder
- UCLA BrainSPORT Program, Los Angeles, California, USA
- Departent of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Fixel Institute, University of Florida, Gainesville, Florida, USA
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Paul Thompson
- Departments of Ophthalmology, Neurology, Psychiatry and the Behavioral Sciences, and Radiology and Engineering, University of Southern California, Los Angeles, California, USA
| | - Jeffery J. Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Christopher T. Whitlow
- Department of Radiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Christopher M. Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Scott Otallah
- Department of Neurology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Joshua Kamins
- Department of Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Philip E. Rosenbaum
- Department of Neurosurgery, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- UCLA BrainSPORT Program, Los Angeles, California, USA
| | - Sara P.D. Chrisman
- Department of Pediatrics, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christopher G. Vaughan
- Department of Neuropsychology, Children's National Hospital and George Washington University School of Medicine, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | - Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David M. Popoli
- Department of Orthopedics and Rehabilitation, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Meeryo Choe
- Department of Pediatric Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jessica Gill
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily L. Dennis
- TBI and Concussion Center, University of Utah, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Christine L. Mac Donald
- Department of Neurological Surgery, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
| | - Frederick P. Rivara
- Department of Pediatrics, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| |
Collapse
|
9
|
Nilles C, Williams JVA, Patten S, Pringsheim T, Orr SL. Association Between Peer Victimization, Gender Diversity, Mental Health, and Recurrent Headaches in Adolescents: A Canadian Population-Based Study. Neurology 2023; 101:e1654-e1664. [PMID: 37532511 PMCID: PMC10624480 DOI: 10.1212/wnl.0000000000207738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/20/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It is unknown whether bullying and gender diversity are associated with increased headache frequency in adolescents. Our study aimed to assess the association between peer victimization, gender diversity, and frequent recurrent headaches in adolescents, while controlling for age, sex, socioeconomic status, and potential confounders (mood and anxiety disorders, suicidality). METHODS This was a cross-sectional observational study of adolescents aged 12-17 years using data from a Canadian population-based health survey. Headache frequency was dichotomized into "≤once/wk" or ">once/wk" (i.e., frequent recurrent headaches). Logistic regression was used to quantify the association between frequent peer victimization (overt or relational), gender diversity (female sex at birth + male gender, male sex at birth + female gender, or gender diverse), mood/anxiety disorder, suicidality, and the odds of frequent recurrent headaches. The fully adjusted multivariable logistic regression model included all exposures and was controlled for age, sex, and socioeconomic status. Bootstrap replicate weighting was used to account for survey design effects. RESULTS There were an estimated 2,268,840 eligible participants (weighted sample size) (mean age = 14.4 years, 48.8% female, 0.5% gender diverse), and 11.2% reported frequent recurrent headaches. Frequent recurrent headaches were associated with older age (odds ratio [OR] = 1.26 per year of age, 95% CI 1.20-1.31), female sex (OR = 2.89, 95% CI 2.47-3.37), and being gender diverse (OR = 3.30, 95% CI 1.64-6.63, adjusted for age/sex). Youth with frequent headaches had higher odds of experiencing both overt and relational bullying compared with peers (OR = 2.69, 95% CI 2.31-3.14, and OR = 3.03, 95% CI 2.58-3.54, adjusted for age/sex). In the fully adjusted model, frequent headaches were no longer associated with gender diversity (OR = 1.53, 95% CI 0.63-3.69) but were still associated with frequent overt and relational peer victimization (OR = 1.82, 95% CI 1.41-2.34, and OR = 1.54, 95% CI 1.17-2.03, respectively), suicidality (OR = 1.83, 95% CI 1.44-2.32), and having a mood or anxiety disorder (OR = 1.50, 95% CI 1.01-2.21, and OR = 1.74, 95% CI 1.24-2.45, respectively). In a model adjusted for age, sex, and mood/anxiety disorders, the risk of suicidality increased incrementally with headache frequency. DISCUSSION Peer victimization and suicidality may be associated with higher headache frequency in adolescents with headaches, independently of mood and anxiety symptoms. Gender-diverse adolescents may have a higher risk of experiencing frequent headaches when compared with cisgender peers, and this may be explained by associated psychosocial factors (anxiety, depression, suicidality, and peer victimization).
Collapse
Affiliation(s)
- Christelle Nilles
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jeanne V A Williams
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Scott Patten
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Tamara Pringsheim
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Serena L Orr
- From the Department of Clinical Neurosciences (C.N., S.P., T.P.), Psychiatry, Pediatrics and Community Health Sciences, University of Calgary; Departments of Community Health Sciences (J.V.A.W.) and Clinical Neurosciences (T.P., S.L.O.), University of Calgary; Mathison Centre for Mental Health Research and Education (S.P., T.P., S.L.O.); Hotchkiss Brain Institute (T.P., S.L.O.), University of Calgary; and Departments of Pediatrics and Community Health Sciences (S.L.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
| |
Collapse
|
10
|
Gelfand AA, Allen IE, Grimes B, Irwin S, Qubty W, Greene K, Waung M, Powers SW, Szperka CL. Melatonin for migraine prevention in children and adolescents: A randomized, double-blind, placebo-controlled trial after single-blind placebo lead-in. Headache 2023; 63:1314-1326. [PMID: 37466211 DOI: 10.1111/head.14600] [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: 04/05/2023] [Revised: 05/12/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Melatonin is effective for migraine prevention in adults. We hypothesized that melatonin would also be effective for migraine prevention in children and adolescents. METHODS This was a randomized, double-blind trial of melatonin (3 mg or 6 mg) versus placebo for migraine prevention in 10-17 year-olds with 4-28/28 headache days at baseline. Participants were recruited from the UCSF Child & Adolescent Headache Program, UCSF child neurology clinic, and social media advertisements. Migraine diagnosis was confirmed by a headache specialist. Participants completed an 8-week single-blind placebo run-in. Those meeting randomization criteria (≥4 headache days and ≥23/28 electronic diary entries during weeks 5-8) were randomized 1:1:1 to placebo:melatonin 3 mg:melatonin 6 mg nightly for 8 weeks. The primary outcome measure was migraine days in weeks 5-8 of randomized treatment between melatonin (combined 6 mg + 3 mg) versus placebo. We aimed to enroll n = 210. RESULTS The study closed early due to slow enrollment (n = 72). Two participants were in the single-blind phase when the study closed, therefore the meaningful n = 70. Sixteen percent (11/70) were lost to follow-up during the single-blind phase. An additional 21% (15/70) did not meet randomization criteria (<4 headache days: n = 5, <23/28 diary days: n = 7, both: n = 3). Sixty-three percent (44/70) were eligible to randomize, of whom 42 randomized (n = 14 per arm). Taking another preventive at enrollment (OR 8.3, 95% CI 1.01 to 68.9) was the only variable associated with meeting randomization criteria. Of those randomized, 91% (38/42) provided diary data in the final 4-weeks. However, given the amount of missing data, only those with ≥21/28 diary days were analyzed-7/14 (50%) in the placebo group, and 20/28 (71%) in the melatonin groups combined. Median (IQR) migraine/migrainous days in weeks 5-8 of double-blind treatment was 2 (1-7) in the placebo group versus 2 (1-12) in the melatonin groups combined; the difference in medians (95% CI for the difference) was 0 days (-9 to 3). There were no differences in adverse events between groups. CONCLUSIONS When compared to recall at enrollment, headache days decreased across the single-blind placebo phase and the double-blind phase. There was no suggestion of superiority of melatonin; however, given the substantial portion of missing data, numerically higher in the placebo arm, and underpowering, this should not be interpreted as proof of inefficacy. Melatonin was generally well tolerated with no serious adverse events. Future migraine preventive trials in this age group may find this trial helpful for anticipating enrollment needs if using a single-blind placebo run-in. Enriching for those already on a migraine preventive may improve randomization rates in future trials, though would change the generalizability of results.
Collapse
Affiliation(s)
- Amy A Gelfand
- Child & Adolescent Headache Program, University of California San Francisco, San Francisco, California, USA
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - I Elaine Allen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Barbara Grimes
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Samantha Irwin
- Child & Adolescent Headache Program, University of California San Francisco, San Francisco, California, USA
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - William Qubty
- Minneapolis Clinic of Neurology, Minneapolis, Minnesota, USA
| | - Kaitlin Greene
- Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon, USA
| | - Maggie Waung
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Scott W Powers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
- Headache Center, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Christina L Szperka
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
11
|
Martin VT, Fassler CS, Brunst KJ, Ying J, Teitelbaum S, Windham GC, Deardorff J, Wolff MS, Kushi LH, Biro FM, Pinney SM. Migraine and its association with pubertal maturation and behavioral traits among adolescent girls. Acta Neurol Belg 2023:10.1007/s13760-022-02161-2. [PMID: 36631631 DOI: 10.1007/s13760-022-02161-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine if the ages at pubertal milestones are associated with the prevalence of adolescent migraine. BACKGROUND Migraine headaches are a common disease in adolescent girls. Past studies have evaluated the relationship between age of onset of menarche and migraine headache, but none have studied earlier pubertal milestones such as thelarche and pubarche. METHODS In this cross-sectional study, a previously validated questionnaire was administered to girls (15-18 years) in Breast Cancer and the Environment Research Program puberty cohort to ascertain if they met criteria for migraine over the past year. Ages of pubertal development were ascertained by serial examinations beginning at 6-8 years of age and ending in late puberty. Logistic regression analyses determined if age of onset of each pubertal milestone (thelarche, pubarche, menarche separately) was associated with adolescent migraine after adjusting for other risk factors. RESULTS Of 761girls, 222 (29.2%) met the criteria for migraine. Later thelarche was associated with a lower odds of adolescent migraine (OR 0.83; 95% CI 0.72-0.97, p = 0.019). In models further adjusted for BASC-2 internalizing problems (n = 490), both later thelarche (OR 0.78; 95% CI 0.64-0.96, p = 0.016) and later menarche (OR 0.81; 95%CI 0.67-0.98, p = 0.026) were associated with a lower migraine prevalence. Internalizing problems (OR 1.05; 95% CI 1.03-1.07) externalizing problems (OR 1.05; 95% CI 1.02-1.07) and behavioral symptoms (OR 1.05; 95% CI 1.03-1.08) were associated with increased prevalence of migraine in separate models. CONCLUSIONS Age of onset of thelarche and menarche, and internalizing, externalizing, and behavioral symptoms were all associated with adolescent migraine.
Collapse
Affiliation(s)
- Vincent T Martin
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cecily S Fassler
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kelly J Brunst
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jun Ying
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan Teitelbaum
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Julianna Deardorff
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Mary S Wolff
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Frank M Biro
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan M Pinney
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Kettering Lab Building, Room 208, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA.
| |
Collapse
|
12
|
Patniyot I, Qubty W. Headache in Adolescents. Neurol Clin 2022; 41:177-192. [DOI: 10.1016/j.ncl.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
13
|
Outpatient Approach to Resistant and Refractory Migraine in Children and Adolescents: a Narrative Review. Curr Neurol Neurosci Rep 2022; 22:611-624. [PMID: 36018499 DOI: 10.1007/s11910-022-01224-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Migraine is one of the top reasons for consulting a pediatric neurologist. Although the majority of children and adolescents who receive evidence-based first-line interventions for migraine will improve substantially, a subset of patients develop resistant or refractory migraine. RECENT FINDINGS In this review, we summarize the level of evidence for a variety of acute and preventive treatment options to consider in children and adolescents with resistant or refractory migraine. We describe the level of evidence for interventional procedures (onabotulinumtoxinA injections, greater occipital and other nerve blocks), neuromodulation (single-pulse transcranial magnetic stimulation, external trigeminal nerve stimulation, remote electrical neuromodulation, and non-invasive vagal nerve stimulation), calcitonin gene-related peptide (CGRP) pathway antagonists (anti-CGRP monoclonal antibodies and gepants), psychological therapies, and manual therapies (acupuncture, craniosacral therapy, massage and physical therapy, and spinal manipulation).
Collapse
|
14
|
Hassan MAE, El-Gharieb HA, Nasr M, Abdelhay WM, Yousef TSM, El-Zamek HMF, Zidan AM, Nady M, Abdel-Kareem MA, Hasan A. Potential Association between Subclinical Hypothyroidism and Childhood Migraine. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101346. [PMID: 36295508 PMCID: PMC9610765 DOI: 10.3390/medicina58101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Migraine is caused by genetic susceptibility that is triggered by environmental as well as biological factors, and it is also linked to many somatic comorbidities, including clinical and subclinical hypothyroidism. We aimed to estimate the potential association between subclinical hypothyroidism (ScH) and migraine in children at our tertiary hospital. Materials and Methods: Using a case−control strategy, 200 children and adolescents were assigned to two equal groups: a case group (patients with migraine) of 100 patients and a control group of 100 patients without migraine. Clinical and biochemical parameters (TSH, FT4) were compared between the groups using statistical analysis. Results: Thyroid function comparison between the groups showed higher TSH but normal FT4 among children with migraine headache compared to the control group, which means more frequent ScH cases among the migraine group relative to the control (17% vs. 2%, p < 0.001). Obesity and overweight were more frequent among patients with migraine than the control group (8 and 5% vs. 2 and 1%, respectively). The (overweight/obese) patients with migraine had about 77% ScH and 15.4% overt hypothyroidism compared to 8% ScH and no overt hypothyroidism among normal body weight migraine patients (p < 0.001). No significant difference in the prevalence of nodular goiter between patients with migraine and controls was found. Conclusions: Based on our results, subclinical hypothyroidism is significantly linked to childhood migraine. Obesity and being overweight are more frequent among patients with migraine. Therefore, it may be logical to test the thyroid function in migraineur children, especially those with high BMI. Further studies are recommended to discover the mechanism of this association in children.
Collapse
Affiliation(s)
| | | | - Mohamed Nasr
- Histology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Wagih M. Abdelhay
- Histology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | | | | | - Ahmed M. Zidan
- Radio-diagnosis Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mohamed Nady
- Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mona A. Abdel-Kareem
- Anatomy Department, Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh 33516, Egypt
| | - Abdulkarim Hasan
- Departments of Pathology, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
- Correspondence: or ; Tel.: +20-002-022-4012-932
| |
Collapse
|
15
|
Nahman-Averbuch H, Schneider VJ, Lee GR, Peugh JL, Hershey AD, Powers SW, de Zambotti M, Coghill RC, King CD. New insight into the neural mechanisms of migraine in adolescents: Relationships with sleep. Headache 2022; 62:668-680. [PMID: 35467018 DOI: 10.1111/head.14299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This case-control study examines if measures of subjective and objective (actigraphic) sleep difficulties mediate alterations in amygdalar connectivity in adolescents with migraine compared to healthy adolescents. BACKGROUND Adolescents with migraine have different functional connectivity of the amygdala compared to individuals without migraine. Sleep is often disturbed in adolescents with migraine, and could contribute to the alterations in functional connectivity. METHODS Twenty adolescents with migraine and 20 healthy controls were recruited from Cincinnati Children's Hospital. Participants completed surveys about their headaches and overall sleep quality, sleep hygiene, and perceived sleep difficulties (Insomnia Severity Scale [ISI]); completed wrist-worn actigraphy; and underwent a magnetic resonance imaging scan. RESULTS Adolescents with migraine differed from healthy controls only in perceived difficulty in sleep initiation and maintenance (ISI: 8.5 ± 4.7 and 4.5 ± 3.7 [mean ± standard deviation], -4.00 [95% confidence: -6.7 to -1.3], p = 0.005) and had greater functional connectivity between the amygdala and the posterior cingulate cortex, precuneus, dorsolateral prefrontal, sensorimotor, and the occipital cortexes. The differences in functional connectivity of the amygdala were not mediated by the subjective/objective sleep measures (ISI/wake minutes after sleep onset). CONCLUSIONS Adolescents with migraine have greater connectivity between the amygdala and areas involved in sensory, affective, and cognitive aspects of pain. These alterations may not be due to higher levels of sleep difficulties in adolescents with migraine, suggesting that both amygdala and sleep alterations may play an independent role in migraine pathophysiology. This advances the understanding of the mechanisms underlying pediatric migraine and can potentially advance migraine management.
Collapse
Affiliation(s)
- Hadas Nahman-Averbuch
- Division of Clinical and Translational Research and Washington University Pain Center, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Victor J Schneider
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Center for Pain Research and Behavioral Health, University of Florida, Gainesville, FL, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Gregory R Lee
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew D Hershey
- Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Robert C Coghill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Pain Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
16
|
Rożniecka A, Minarowska A. Tools for Evaluating the Quality of Life of the Paediatric Population with Primary Headaches-A Review of Selected Questionnaires. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6295. [PMID: 35627830 PMCID: PMC9141686 DOI: 10.3390/ijerph19106295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
Abstract
Primary headaches are a common health issue in the paediatric population. These conditions have a negative impact on the quality of life of patients at the development age in every area of their lives. The aim of this study is to list the tools used to evaluate the quality of life of the paediatric population with primary headaches and to discuss their advantages and limitations. Examining the quality of life of children and adolescents suffering from primary headaches is of particular importance. This is a consequence of a high disease incidence rate and a considerable negative impact of the ailment on the everyday life of this population. It is very important to conduct such examinations with specific and validated tools. It is significant because of the particular features of the areas of patients' lives at the developmental age. Each of the available questionnaires has specific characteristics, advantages and limitations. The data accumulated in this literature review can be of help in designing research on the quality of life of children and adolescents suffering from primary headaches.
Collapse
Affiliation(s)
- Adrianna Rożniecka
- Department of Nursing, Public Health School, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Alina Minarowska
- Department of Pulmonology, Public Health School, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland;
| |
Collapse
|
17
|
Forgeron PA, Dick BD, Chambers C, Cohen J, Lamontagne C, Finley GA. Are They Still Friends? Friendship Stability of Adolescents With Chronic Pain: 1-Year Follow-Up. FRONTIERS IN PAIN RESEARCH 2022; 2:767236. [PMID: 35295468 PMCID: PMC8915730 DOI: 10.3389/fpain.2021.767236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Most adolescents identify their best friend as their main source of social support. Adolescents with chronic pain (ACP) report the loss of friendships due to pain. Friendships protect against loneliness and depression, yet adolescents with pain experience increased levels of loneliness and depression compared to peers. This longitudinal study examines the friendship stability of dyads that included an adolescent with chronic pain compared to non-pain friendship dyads as well as the factors contributing to a friendship breakup. Eighty-three participants from 61 same-sex friendship dyads across 3 sites participated in a 1-year follow-up survey designed to capture friendship features, indices of social-emotional well-being, pain characteristics, and friendship stability. Chi-square, repeated measures ANOVA, and logistic regression were used to analyze the data. Dyads that included an ACP experienced higher rates of friendship breakup. The shorter length of friendship and having chronic pain predicted a friendship breakup at time 2. ACP continues to experience worse scores on indices of social-emotional well-being that are not predicted with a friendship breakup. Understanding what contributes to positive long-term friendships for those with pain may inform strategies to maintain and improve friendships for those with pain and who experience social challenges.
Collapse
Affiliation(s)
- Paula A. Forgeron
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesia, Dalhousie University, Halifax, NS, Canada
- Children's Hospital of Eastern Ontario's Research Institute, Ottawa, ON, Canada
- *Correspondence: Paula A. Forgeron
| | - Bruce D. Dick
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christine Chambers
- Pediatrics and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Psychology, Dalhousie University, Halifax, NS, Canada
| | - Janice Cohen
- Behavioural Neurosciences and Consultation Liaison Team, Mental Health, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Christine Lamontagne
- Children's Hospital of Eastern Ontario's Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gordon Allen Finley
- Department of Anesthesia, Dalhousie University, Halifax, NS, Canada
- Psychology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
18
|
Tekin H, Edem P. Effects and side effects of migraine prophylaxis in children. Pediatr Int 2022; 64:e15094. [PMID: 34905279 DOI: 10.1111/ped.15094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/29/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Migraine is the primary cause of headache in children. Most patients can be treated with lifestyle changes and acute attack prophylaxis. Prophylaxis should be considered when symptoms cause frequent school absenteeism, poor quality of life, recurring emergency room visits, and frequent analgesic use. We aimed to compare the efficacy and side effects of drugs used in migraine prophylaxis, chosen according to the clinical and/or demographic characteristics of the patients. METHODS One hundred eighty-six patients aged 6-18 years were evaluated and who were diagnosed with migraine according to The International Classification of Headache Disorders, 3rd edition beta version (ICH-3β). Propranolol, topiramate, flunarizine, and cyproheptadine were given as prophylactic treatment. The Pediatric Migraine Disability Assessment Score (PedMIDAS) score, severity, duration, and frequency of the headache attacks were evaluated from the medical records and pre- and post-treatment values were compared. RESULTS The median age of the patients was 14 years (range, 6-18 years) and the mean duration of headache was 29.6 ± 21.02 months. The mean PedMIDAS score was 29.9 ± 21.2 before and 14.9 ± 12.5 after treatment. Most reduction in the frequency of attacks was observed in the topiramate group. All four drugs significantly reduced the PedMIDAS score. The most common side effect was palpitations. CONCLUSIONS Significant improvement was found in PedMIDAS scores in all drug groups. Topiramate was found to be the most effective drug in reducing the frequency of attacks. All four drugs in this study may be utilized for migraine prophylaxis in terms of effectiveness and safety.
Collapse
Affiliation(s)
- Hande Tekin
- Division of Pediatric Neurology, Department of Pediatrics, Bakircay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Pınar Edem
- Division of Pediatric Neurology, Department of Pediatrics, Bakircay University Cigli Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
19
|
Reidy BL, Powers SW, Coffey CS, Chamberlin LA, Ecklund DJ, Klingner EA, Yankey JW, Korbee LL, Porter LL, Peugh J, Kabbouche MA, Kacperski J, Hershey AD. Multimodal Assessment of Medication Adherence Among Youth With Migraine: An Ancillary Study of the CHAMP Trial. J Pediatr Psychol 2021; 47:376-387. [PMID: 34865085 DOI: 10.1093/jpepsy/jsab123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Examine preventive medication adherence among youth with migraine. METHODS Adherence (self-report, pill count, and blood serum drug levels) was assessed as an ancillary study that utilized data from 328 CHAMP Study participants (ages 8-17). CHAMP was a multisite trial of preventive medications. Participants completed a prospective headache diary during a six-month active treatment period during which youth took amitriptyline, topiramate, or placebo pill twice daily. Self-reported medication adherence was collected via daily diary. At monthly study visits, pill count measures were captured. At trial month 3 (trial midpoint) and 6 (end of active trial), blood serum drug levels were obtained. Self-report and pill count adherence percentages were calculated for the active trial period, at each monthly study visit, and in the days prior to participants' mid-trial blood draw. Percentages of nonzero drug levels were calculated to assess blood serum drug level data. Adherence measures were compared and assessed in context of several sociodemographic factors. Multiple regression analyses investigated medication adherence as a predictor of headache outcomes. RESULTS Self-report and pill count adherence rates were high (over 90%) and sustained over the course of the trial period. Serum drug level adherence rates were somewhat lower and decreased significantly (from 84% to 76%) across the trial period [t (198) = 3.23, p = .001]. Adherence measures did not predict headache days at trial end; trial midpoint serum drug levels predicted headache-related disability. CONCLUSIONS Youth with migraine can demonstrate and sustain relatively high levels of medication adherence over the course of a clinical trial.
Collapse
Affiliation(s)
- Brooke L Reidy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Christopher S Coffey
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa, USA
| | - Leigh A Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - Dixie J Ecklund
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa, USA
| | - Elizabeth A Klingner
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa, USA
| | - Jon W Yankey
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa, USA
| | | | - Linda L Porter
- The National Institute of Neurological Disorders and Stroke, USA
| | - James Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
| | - Marielle A Kabbouche
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, USA
| | - Joanne Kacperski
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, USA
| | - Andrew D Hershey
- Department of Pediatrics, University of Cincinnati College of Medicine, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, USA
| | | |
Collapse
|
20
|
Powers SW, Coffey CS, Chamberlin LA, Ecklund DJ, Klingner EA, Yankey JW, Peugh JL, Korbee LL, Simmons K, Sullivan SM, Kabbouche MA, Kacperski J, Porter LL, Reidy BL, Hershey AD. Prevalence of Headache Days and Disability 3 Years After Participation in the Childhood and Adolescent Migraine Prevention Medication Trial. JAMA Netw Open 2021; 4:e2114712. [PMID: 34251445 PMCID: PMC8276084 DOI: 10.1001/jamanetworkopen.2021.14712] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Migraine is a common neurological disease that often begins in childhood and continues into adulthood; approximately 6 million children and adolescents in the United States cope with migraine, and many frequently experience significant disability and multiple headache days per week. Although pharmacological preventive treatments have been shown to offer some benefit to youth with migraine, additional research is needed to understand whether and how these benefits are sustained. OBJECTIVE To survey clinical status of youth with migraine who participated in the 24-week Childhood and Adolescent Migraine Prevention (CHAMP) trial over a 3-year follow-up period. DESIGN, SETTING, AND PARTICIPANTS This survey study used internet-based surveys collected from youth ages 8 to 17 years at 3, 6, 12, 18, 24, and 36 months after completion of the CHAMP trial, which randomized participants to amitriptyline, topiramate, or placebo. At the end of the trial, the study drug was stopped, and participants received clinical care of their choice thereafter. The CHAMP trial was conducted between May 2012 and November 2015, and survey follow-up was conducted June 2013 to June 2018. Participants in this survey study were representative of those randomized in the trial. Data were analyzed from March 2020 to April 2021. EXPOSURES Survey completion. MAIN OUTCOMES AND MEASURES Headache days, disability (assessed using the Pediatric Migraine Disability Scale [PedMIDAS]), and self-report of ongoing use of prescription preventive medication. RESULTS A total of 205 youth (mean [SD] age, 14.2 [2.3] years; 139 [68%] girls; mean [SD] history of migraine, 5.7 [3.1] years) participated in the survey. Retention of participants was 189 participants (92%) at month 6, 182 participants (88%) at month 12, 163 participants (80%) at month 18, 165 participants (80%) at month 24, and 155 participants (76%) at month 36. Over the course of the 3-year follow-up, participants consistently maintained meaningful reductions in headache days (mean [SD] headache days per 28 days: CHAMP baseline, 11.1 [6.0] days; CHAMP completion, 5.0 [5.7] days; 3-year follow-up, 6.1 [6.1] days) and disability (mean [SD] score: CHAMP baseline, 40.9 [26.4]; CHAMP completion, 17.9 [22.1]; 3-year follow-up, 12.3 [20.0]). At 3 years after completion of the CHAMP trial, headache days were approximately 1.5 per week (changed from about 3 per week at trial baseline) and disability had improved from the moderate range to the low mild range on the PedMIDAS. Longitudinal analyses showed that amitriptyline and topiramate did not explain intercept random effects for either mean rate of headache days per week (amitriptyline: estimate [SE], 0.07 [0.05]; P = .16; topiramate: estimate [SE], 0.04 [0.05]; P = .50) or headache disability PedMIDAS total score (amitriptyline: estimate [SE], 0.25 [0.38]; P = .52; topiramate: estimate [SE], -0.09 [0.39]; P = .82) changes over time. Of 153 participants who reported on prescription drug use at 3 years, only 1 participant (1%) reported using prevention medication, and most participants reported no medication use at most time points. CONCLUSIONS AND RELEVANCE These findings suggest that children and adolescents with longer than 5 years history of migraine who participated in the CHAMP trial may sustain positive clinical outcomes over time, even after discontinuing preventive pill-based treatment. This survey study could inform use and discontinuation timing of pharmacological preventive therapies for migraine in youth ages 8 to 17 years. Research is needed to examine mechanisms of treatment improvement and maintenance for preventive therapies, as well as placebo, in the pediatric population.
Collapse
Affiliation(s)
- Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Cincinnati Children’s Headache Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christopher S. Coffey
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa College of Public Health, Iowa City
| | - Leigh A. Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Dixie J. Ecklund
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa College of Public Health, Iowa City
| | - Elizabeth A. Klingner
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa College of Public Health, Iowa City
| | - Jon W. Yankey
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa College of Public Health, Iowa City
| | - James L. Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Kerry Simmons
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie M. Sullivan
- Office for Clinical and Translational Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Marielle A. Kabbouche
- Cincinnati Children’s Headache Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joanne Kacperski
- Cincinnati Children’s Headache Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Linda L. Porter
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Brooke L. Reidy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Cincinnati Children’s Headache Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew D. Hershey
- Cincinnati Children’s Headache Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
21
|
Landgraf MN, Heinen F, Gerstl L, Kainz C, Ruscheweyh R, Straube A, Scheidt J, von Mutius S, Obermeier V, von Kries R. Comparison of a pediatric practice-based therapy and an interdisciplinary ambulatory treatment in social pediatric centers for migraine in children: a nation-wide randomized-controlled trial in Germany: "moma - modules on migraine activity". BMC Pediatr 2021; 21:294. [PMID: 34193110 PMCID: PMC8241883 DOI: 10.1186/s12887-021-02757-2] [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: 05/07/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
Background Migraine is common in childhood, peaks in adolescents and persists into adulthood in at least 40% of patients. There is need for early interventions to improve the burden of disease and, if possible, reduce chronification. The aim of the project is to compare two types of ambulatory treatment strategies regarding their effect on headache days and quality of life in 6 to 11 year old children with migraine: 1) the routine care in pediatricians’ practices (intervention group A) and 2) a structured interdisciplinary multimodal intervention administered at social pediatric centers (intervention group B). Methods The study is a nation-wide cluster-randomized study. Based on the postal codes the regions are randomly assigned to the two intervention-strategies. Children with migraine are recruited in the pediatric practices, as common outpatient-care in the German health-care system. Parents rate headache frequency, intensity and acute medication intake at a daily basis via a digital smartphone application specifically designed for the study. Migraine-related disability and quality of life are assessed every 3 months. Study duration is 9 months for every participant: 3 months of baseline at the pediatric practice (both groups); 3 months of intervention at the pediatric practice (intervention group A) or at the social pediatric center (intervention group B), respectively; 3 months of follow-up at the pediatric practice (both groups). Discussion Results of the planned comparison of routine care in pediatric practices and interdisciplinary social pediatric centers will be relevant for treatment of children with migraine, both for the individual and for the health care system. Trial registration The study was approved by the ethics committee at the Ludwig-Maximilians-University Munich (number 18–804) and was retrospectively registered on 27 April 2021 in the WHO approved German Clinical Trials Register (number DRKS00016698).
Collapse
Affiliation(s)
- Mirjam N Landgraf
- Department for Neuropediatrics, Developmental Medicine and Social Pediatrics, LMU Center for Development and Children with Medical Complexity - iSPZ Hauner, Dr. von Haunersches Kinderspital, Kinderklinik und Kinderpoliklink der Ludwig Maximilians Universitat Munchen, Munich, Germany.
| | - Florian Heinen
- Department for Neuropediatrics, Developmental Medicine and Social Pediatrics, LMU Center for Development and Children with Medical Complexity - iSPZ Hauner, Dr. von Haunersches Kinderspital, Kinderklinik und Kinderpoliklink der Ludwig Maximilians Universitat Munchen, Munich, Germany
| | - Lucia Gerstl
- Department for Neuropediatrics, Developmental Medicine and Social Pediatrics, LMU Center for Development and Children with Medical Complexity - iSPZ Hauner, Dr. von Haunersches Kinderspital, Kinderklinik und Kinderpoliklink der Ludwig Maximilians Universitat Munchen, Munich, Germany
| | - Christine Kainz
- Department for Neuropediatrics, Developmental Medicine and Social Pediatrics, LMU Center for Development and Children with Medical Complexity - iSPZ Hauner, Dr. von Haunersches Kinderspital, Kinderklinik und Kinderpoliklink der Ludwig Maximilians Universitat Munchen, Munich, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig-Maximilians-Universitat Munchen, Munich, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians-Universitat Munchen, Munich, Germany
| | - Joerg Scheidt
- Hochschule Hof, Institute of Information Systems, Hof, Germany
| | - Sabine von Mutius
- Ludwig-Maximilians-Universitat Munchen, Institute for Social Pediatrics and Adolescent Medicine, Munich, Germany
| | - Viola Obermeier
- Ludwig-Maximilians-Universitat Munchen, Institute for Social Pediatrics and Adolescent Medicine, Munich, Germany
| | - Ruediger von Kries
- Ludwig-Maximilians-Universitat Munchen, Institute for Social Pediatrics and Adolescent Medicine, Munich, Germany
| |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW This article reviews the approach to a child or adolescent with headache, the criteria for common diagnoses, and the evidence base for treatments. RECENT FINDINGS The guidelines for acute and preventive treatment of migraine were updated in 2019. These guidelines summarize the available evidence and outline the questions that should be addressed in future research. The US Food and Drug Administration (FDA) approval of several new classes of drugs and devices to treat adult migraine in the past few years has resulted in ongoing or planned pediatric trials. SUMMARY Headache is a common symptom in children, and it is important to take a detailed history and perform a thorough physical examination to make the diagnosis. Nearly 1 in 10 children experience recurrent headaches due to migraine, which cause significant impairment in school performance and quality of life. The acute and preventive treatments that are currently available will help at least two-thirds of children with migraine, and several trials of new therapies offer hope for the future.
Collapse
|
23
|
Predictors of Improvement in Pediatric Chronic Migraine: Results from the Cognitive-Behavioral Therapy and Amitriptyline Trial. J Clin Psychol Med Settings 2021; 29:113-119. [PMID: 34028656 DOI: 10.1007/s10880-021-09782-4] [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] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Explore predictors of improvement in headache days and migraine-related disability through a secondary analysis of the cognitive-behavioral therapy plus amitriptyline trial in children and adolescents (Clinical Trials Registration Number: NCT00389038). Participants were 135 youth aged 10-17 years old diagnosed with chronic migraine. Predictor variables included group assignment (treatment or control), baseline scores from depression and quality of life measures, and demographic variables. Criterion variables included headache days and migraine-related disability. Higher baseline depression scores were indicative of more days with headache post-treatment regardless of group assignment. Family income at the higher-end of the low-income range was significantly associated with less migraine-related disability regardless of group assignment (Household Income: HINC-01 in The United States Census Bureau. Bureau, U, 2020). Results from this secondary analysis identify depression symptoms and family income as predictors that can impact headache frequency and migraine-related disability. Self-reported symptoms of depression and family income are important factors to consider as part of the biopsychosocial model of care.
Collapse
|
24
|
Connelly MA, Boorigie ME. Feasibility of using "SMARTER" methodology for monitoring precipitating conditions of pediatric migraine episodes. Headache 2020; 61:500-510. [PMID: 33382086 DOI: 10.1111/head.14028] [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] [Received: 08/26/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the feasibility in children of an intensive prospective data monitoring methodology for identifying precipitating conditions for migraine occurrence. BACKGROUND Migraine headaches are a common pain condition in childhood and can become increasingly chronic and disabling with repeated episodes. Identifying conditions that forecast when a child's migraine is likely to occur may facilitate next-generation adaptive treatments to prevent future migraine attacks. METHODS In this cohort study of a sample of 30 youth (ages 10-17) with migraine recruited through a pediatric headache clinic, smartphones supplemented with wearable biosensors were used over a period of 28 days to collect contextual data thought to be potentially relevant to headache occurrence. Self-reported data on headache occurrence, lifestyle, and perceptions of the environment were collected in 4 epochs per day using custom real-time reporting software. Data derived from the wearable biosensor included information on autonomic arousal and physical activity. Built-in sensors on participants' own phones also were used to indicate location and to quantify the sensory environment (e.g., ambient noise and light levels). Data fidelity was monitored to evaluate feasibility of the methods, and participant acceptability was assessed via an end-of-study survey. RESULTS Self-report data were obtained on a mean of 88.9% (24.9/28) of assigned days (SD = 22.4%) and at a mean of 68.9% (77.2/112) of assigned moments (SD = 24.5%). Data from the wearable biosensor were obtained for a mean of 18.7 hours per day worn (SD = 2.3 hours), with participants on average wearing the sensor on 20.3 days (SD = 9.9). Fidelity of obtaining objective data from phone sensors on the sensory environment and other environmental conditions was highly variable, with these data obtainable from 5 to 22/30 (16.7%-73.3%) of participants' own phones. Most participants (63.3%-100%) responded with at least "somewhat agree" to questions about acceptability of the study methods. However, 5 to 7/30 (16.7%-23.3%) patients indicated difficulties with burden and remembering to wear the sensor. Almost all participants (29/30, 96.7%) agreed that they would want information about when a migraine might occur. CONCLUSIONS A contemporary data sampling approach comprising ambulatory sensors and real-time reporting appears to be acceptable to most youth with migraine in this study. Reliability of acquiring some data sources from participants' own phones, however, was suboptimal. Further refining these data sampling methods may enable a novel means of predicting and preventing recurrences of migraine episodes in youth.
Collapse
Affiliation(s)
- Mark A Connelly
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA
| | | |
Collapse
|
25
|
Pan YJ, Chen YC, Lu SR, Juang KD, Chen SP, Wang YF, Fuh JL, Wang SJ. The influence of friendship on migraine in young adolescents: A social network analysis. Cephalalgia 2020; 40:1321-1330. [PMID: 32635765 DOI: 10.1177/0333102420940700] [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: 12/30/2022]
Abstract
OBJECTIVE The current study explored whether the chances of having migraine are influenced by a youth's friendship with a migraineur. METHODS The study was centered on a community-based non-referral cohort of eighth graders from two middle schools in Taiwan. Among the 642 recruited adolescent students, 610 (95%) (mean age 14.1 years, male ratio 51.2%) nominated three good friends and completed a validated headache questionnaire for migraine diagnosis at the follow-up survey 1 year later. To explore social influences on incident migraine, we used longitudinal statistical models to examine whether the development of migraine in one adolescent during the 1-year observational period was associated with that in his/her friends. RESULTS Overall, 1700 social ties were established in the social network based on the reported lists of good friends. Randomization test for the homophily effect demonstrated that the students with migraine tended to cluster together in the social network even when those with incident migraine were also considered (p = 0.003). Besides, when friendship choices were mutual, the relative risk of an adolescent becoming a migraineur was 3.26 (95% CI: 1.25-8.47, p = 0.015) if his/her friend became a migraineur (induction) during the 1-year observational period. CONCLUSION To the best of our knowledge, this is the first study to demonstrate that migraine may spread through social networks in young adolescents. Both homophily and induction effects are possibly contributory.
Collapse
Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Institute of Public Health, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Chun Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiang-Ru Lu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kai-Dih Juang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Psychiatry, Centro Hospitalar Conde de Sao Januario, Macau
| | - Shih-Pin Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Feng Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
26
|
Al-Hashel JY, Alroughani R, Shuaibi S, AlAshqar A, AlHamdan F, AlThufairi H, Owayed S, Ahmed SF. Impact of primary headache disorder on quality of life among school students in Kuwait. J Headache Pain 2020; 21:80. [PMID: 32580704 PMCID: PMC7313161 DOI: 10.1186/s10194-020-01124-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary headache disorders have being increasingly reported in younger populations. They can have significant effects on their quality of life and academic achievement and may cause significant distress to their families. AIMS AND OBJECTIVES To assess the burden of primary headache disorder and its impact on the quality of life on school student in Kuwait. METHODS A cross-sectional study was conducted among Kuwaiti primary and middle school students of both genders in randomly selected schools located in two governorates in 2018/2019 academic year. Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents was used to assess the impact of primary headaches on the quality of life. RESULTS One thousand and ninety-one questionnaires were completed by primary and middle school students of both genders; of whom 466 students (girls 321 (68.88%) were diagnosed with primary headache disorders with mean age 11.98 ± 2.03 years. In the month prior to the survey, the effect of the headache was variable. The students lost a mean of 1.99 ± 2.015 days of school while they could not perform their usual activities for a mean of 2.84 ± 4.28 days. Their parents lost a mean of 2 ± 2.03 days of work because of headaches of their children and parents prohibited 5.7% of the students to engage in any activity due to their headaches. Difficulties in concentrations were reported as never sometimes (39.1%), often (24.8%), and always (26%). Majority of the students (51.5%) experienced a feeling of sadness ranging from sometimes to always. Most of the students (67.3%) struggled to cope with the headache and 22.4% were never able to cope. Additionally, 19.4% of students reported they did not want others noticing their headache. CONCLUSION Primary headache disorder can have a significant impact on the quality of life in children. It can affect their engagement in activities and academic achievement. Implementing strategies to properly manage schoolchildren with primary headaches can have profound effects on their quality of life.
Collapse
Affiliation(s)
- Jasem Y Al-Hashel
- Neurology Department, Ibn Sina Hospital, P.O. Box 25427, Safat, 13115, Kuwait City, Kuwait.
- Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait City, Kuwait.
| | - R Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Arabian Gulf Street, 11013, Sharq, Kuwait
| | - S Shuaibi
- Internal Medicine Department, Ministry of Health, Kuwait City, Kuwait
| | - A AlAshqar
- Obstetrics and Gynecology Department, Ministry of Health, Kuwait City, Kuwait
| | - F AlHamdan
- Department of Medicine, Faculty of Medicine, Health Sciences Centre, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait City, Kuwait
| | - H AlThufairi
- Internal Medicine Department, Ministry of Health, Kuwait City, Kuwait
| | - S Owayed
- Internal Medicine Department, Ministry of Health, Kuwait City, Kuwait
| | - Samar F Ahmed
- Neurology Department, Ibn Sina Hospital, P.O. Box 25427, Safat, 13115, Kuwait City, Kuwait
- Neuropsychiatry department, Faculty of Medicine, Al-Minia University, P.O. Box 61519, Minia City, Minia, 61111, Egypt
| |
Collapse
|
27
|
Orr SL, Turner A, Kabbouche MA, Horn PS, O’Brien HL, Kacperski J, LeCates S, White S, Weberding J, Miller MN, Powers SW, Hershey AD. The Profile and Prognosis of Youth With Status Migrainosus: Results From an Observational Study. Headache 2020; 60:878-888. [DOI: 10.1111/head.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Serena L. Orr
- Department of Pediatrics, Clinical Neurosciences and Community Health Sciences University of Calgary Calgary Canada
| | - Abigail Turner
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - Marielle A. Kabbouche
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA
| | - Paul S. Horn
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA
| | - Hope L. O’Brien
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA
| | - Joanne Kacperski
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA
| | - Susan LeCates
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - Shannon White
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - Jessica Weberding
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - Mimi N. Miller
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
| | - 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
| | - Andrew D. Hershey
- Division of Neurology Cincinnati Children’s Hospital Medical Center Cincinnati OH USA
- Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH USA
| |
Collapse
|
28
|
Al-Hashel JY, Ahmed SF, Alroughani R. Prevalence and Burden of Primary Headache Disorders in Kuwaiti Children and Adolescents: A Community Based Study. Front Neurol 2019; 10:793. [PMID: 31417482 PMCID: PMC6682654 DOI: 10.3389/fneur.2019.00793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/09/2019] [Indexed: 01/11/2023] Open
Abstract
Background/Objective: Primary headaches are common in the pediatric and adolescent population and can be disabling for them and their families. We aimed to assess the prevalence and burden of primary headache disorders among children and adolescents in Kuwait. Methods: A cross-sectional community-based study included Kuwaiti population aged 6–17 years. They were randomly recruited from all six governorates of Kuwait using stratified multistage cluster sampling. The Headache-Attributed Restriction, Disability, and Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents was used to collect the data. Results: Data were collected from 3,423 subjects; 664 subjects were diagnosed as having primary headache disorders. The mean age was 12.61 ± 2.51 years and 64.2% were females. One year prevalence of headache was 19.4%. It was significantly prevalent in females compared to males (25.2% vs. 13.8%; P < 0.001). Primary headache disorder significantly increased in age group 12–17 when compared to age group 6–11 years (25.8% vs. 10.4 %; p < 0.001). One year primary headache prevalence showed non-significant differences in both males and females in age group 6–11 years (10.1% in males vs. 10.6% in females; P < 0.79), while it was significantly higher in female vs. males (38.1% vs. 15.8%; P < 0.001) in age group 12–17 years. Migraine prevalence was 10.9% followed by tension type headache (TTH) 6.2% and chronic headache 0.9%. Medical care utilization was reported in 67% of our cohort. The majority (95%) of the patients received symptomatic drugs for headache attacks and only 7.5% used preventive medication. The students with headache lost a mean of 1.29 ± 1.23 days of school, reported mean of 1.16 ± 1.50 days they could not do activities they had wanted to. Their parents lost a mean of 1.01 ± 1.02 days of work because of headaches of their children during the preceding 4 weeks of the study. Conclusions: The estimated 1 year prevalence of headache was 19.4% overall. Primary headache prevalence increased with age and it was more prevalent in female adolescents compared to males of the same age. Headache disorders in children/adolescents affect school and social activities as well as their parents work. The awareness for early diagnosis and preventive medications for headache in this age group may reduce the headache burden.
Collapse
Affiliation(s)
- Jasem Yousef Al-Hashel
- Neurology Department, Ibn Sina Hospital, Kuwait City, Kuwait.,Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Samar Farouk Ahmed
- Neurology Department, Ibn Sina Hospital, Kuwait City, Kuwait.,Division of Neurology, Amiri Hospital, Kuwait City, Kuwait
| | - Raed Alroughani
- Department of Neuropsychiatry, Minia University, Minia, Egypt
| |
Collapse
|
29
|
Kılıç B, Kılıç M. Evaluation of Vitamin D Levels and Response to Therapy of Childhood Migraine. ACTA ACUST UNITED AC 2019; 55:medicina55070321. [PMID: 31261815 PMCID: PMC6681503 DOI: 10.3390/medicina55070321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/19/2022]
Abstract
Background and Objectives: Vitamin D deficiency and insufficiency are related with many neurological diseases such as migraine. The aim of this study was to investigate whether pediatric migraine is associated with vitamin D deficiency and the effect of vitamin D therapy on the frequency, duration, severity of migraine attacks, and Pediatric Migraine Disability Assessment (PedMIDAS). Materials and Methods: We retrospectively examined the patients’ levels of calcium, phosphorus, parathyroid hormone, alkaline phosphatase, and 25-OH vitamin D of 92 pediatric migraine patients. The patients were divided into two groups: Group 1, which had low vitamin D levels and received vitamin D therapy, and group 2, which had normal vitamin D levels and did not receive vitamin D therapy. Migraine severity measured by the visual analog scale (VAS), migraine frequency, and duration as well as scores on the PedMIDAS questionnaire were compared with regard to the 25-OH vitamin D levels. In addition, pre- and posttreatment pedMIDAS scores, VAS, migraine frequency, and duration were compared with baseline values. Results: A total of 34.7% patients had vitamin D insufficiency (vitamin D levels between 10 and 20 ng/mL), whereas 10.8% had vitamin D deficiency (vitamin D levels < 10 ng/mL). Migraine frequency, migraine duration, and PedMIDAS scores were significantly higher in the group 1 than group 2 (p = 0.004, p = 0.008, and p = 0.001). After vitamin D therapy at sixth months of supplementation, migraine duration was reported statistically significant shorter (p < 0.001) and the migraine frequency, VAS scores, and pedMIDAS scores were statistically significant lower compared with baseline values in group 1 (p < 0.001). Conclusion: We found a marked correlation between pediatric migraine and vitamin D levels. Vitamin D therapy was beneficial in migraine pediatric patients.
Collapse
Affiliation(s)
- Betül Kılıç
- Department of Child Neurology, University of Health Sciences, Derince Training and Research Hospital, 41900 Kocaeli, Turkey.
| | - Mustafa Kılıç
- Department of Neurosurgery, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, 34371 Istanbul, Turkey.
| |
Collapse
|
30
|
Abstract
Inhibitory pain modulation has been reported to be deficient in adults across different types of chronic pain, including migraine. To determine whether a similar phenomenon occurs in youth, we performed a quantitative sensory testing investigation in adolescents with migraine (N = 19). These patients were compared to healthy adolescents with (Fam-His; N = 20) or without (Healthy; N = 29) a family history of migraine (eg, first-degree relative with migraine). Subjects were first familiarized with the stimuli and visual analogue rating scales using graded noxious stimuli (0°C, 43-49°C range). These data were used to explore potential pain sensitivity differences between the groups. Pain inhibition was assessed by conditioned pain modulation (CPM), which used both suprathreshold heat pain (heat CPM) and pressure pain thresholds (pressure CPM) as the test stimuli before and during cold-water immersion (8°C). In response to the graded heat stimuli, Fam-His participants reported higher pain intensity ratings compared with patients with migraine, who in turn reported higher pain intensity ratings than the healthy controls (F = 3.6, [df = 2, 459], P = 0.027). For heat and pressure CPM, there was no significant group difference in the magnitude of CPM responses. Thus, adolescents with migraine and healthy adolescents have similar inhibitory pain modulation capability, despite having marked differences in pain sensitivity. Although Fam-His participants are asymptomatic, they demonstrate alterations in pain processing, which may serve as markers for prediction of migraine development.
Collapse
|
31
|
Clinical presentation, diagnosis and polysomnographic findings in children with migraine referred to sleep clinics. Sleep Med 2019; 63:57-63. [PMID: 31606650 DOI: 10.1016/j.sleep.2019.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE An association between migraine and sleep disturbances in children was reported, yet limited clinical data exist. The current study addresses the clinical presentation, polysomnographic (PSG) characteristics, and comorbid sleep diagnoses of children with migraine referred to the sleep clinic. PATIENTS A retrospective review was performed of headache center patients evaluated by the sleep center between 2007 and 2017. Children ≤18 years old, diagnosed with migraine headache, and who had PSG within one year of evaluation in the headache clinic, were included. PSG findings, as well as demographics, were compared to a group of controls aged 5-14 years-old. RESULTS In sum, 185 children with a diagnosis of migraine were included: 39% males, 75% Caucasian, mean age 13.5 ± 3.4, and 57% obese. Additionally, 180 children were included in the control group. The common presenting sleep symptoms were snoring (66%), sleep onset and sleep maintenance problems (25%), and excessive daytime sleepiness (20%). For the sleep diagnosis, 40% had obstructive sleep apnea (OSA), 27% had insomnia, 15% had periodic limb movement disorder (PLMD), and 6% had a central disorder of hypersomnolence. In terms of sleep architecture, children with migraine had significantly higher NREM 2 (p < 0.001) and a lower percentage of NREM3 (p < 0.001) compared to controls after adjustment for demographics and the presence of sleep-disordered breathing. CONCLUSIONS Children referred to the sleep clinic who also had migraine, experience various types of sleep complaints. OSA, insomnia, and PLMD were relatively common in this population. Changes in sleep architecture, specifically increased NREM2 and decreased slow wave sleep compared to the control group, were also observed.
Collapse
|
32
|
Filiz S, Kutluk MG, Uygun DFK. Headache deteriorates the quality of life in children with chronic spontaneous urticaria. Allergol Immunopathol (Madr) 2019; 47:254-259. [PMID: 30686612 DOI: 10.1016/j.aller.2018.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/18/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Quality of life, which is impaired in patients with chronic spontaneous urticaria (CSU), is influenced by comorbid mental disorders. Headaches could be another comorbid mental disorder that affects quality of life in children with CSU. OBJECTIVES To investigate the effect of headaches on urticaria symptoms, disease activity and quality of life in children with CSU. METHODS A total of 83 patients with CSU were enrolled in the study and were separated into two groups as those with or without headache. Demographic and clinical characteristics were studied with the Urticaria Activity Score (UAS7), Urticaria Control test (UCT) and Chronic Urticaria Quality of Life Questionnaire (CU-Q2QoL). The headache questionnaire designed according to the Department of International Classification of Headache Disorders, second edition (ICHD-II) was used and VAS (Visual Analogue Scale) and NRS (Numerical Rating Scale) were used to assess the pain measurement. In patients diagnosed with migraine, the paediatric Migraine Disability Assessment Scale (PedMIDAS) was applied. RESULTS CU-QoL total scores were significantly higher in patients with CSU with headache than in those without headache (p=0.015). In the five domains of CU-QoL, impact of daily life activities domain and sleep problems domain had higher scores in CSU with headache (p=0.008, 0.028, respectively). There was no significant relationship between UCT, UAS and CU-QoL and headache severity (p<0.05). No differences were found between the groups in respect of duration of urticaria, UAS7 and UCT. CONCLUSION Headache may be an important factor that affects and impairs quality of life in children with chronic urticaria.
Collapse
Affiliation(s)
- S Filiz
- Training and Research Hospital, Department of Pediatric Allergy and Immunology, Antalya, Turkey.
| | - M G Kutluk
- Training and Research Hospital, Department of Pediatric Neurology, Antalya, Turkey
| | - D F K Uygun
- Akdeniz University, Department of Pediatric Allergy and Immunolgy, Antalya, Turkey
| |
Collapse
|
33
|
Orr SL, Turner A, Kabbouche MA, Horn PS, O'Brien HL, Kacperski J, LeCates S, White S, Weberding J, Miller MN, Powers SW, Hershey AD. Predictors of Short-Term Prognosis While in Pediatric Headache Care: An Observational Study. Headache 2019; 59:543-555. [PMID: 30671933 DOI: 10.1111/head.13477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To characterize the short-term prognosis of a clinical population of pediatric and young adult patients with migraine and explore predictors of clinical worsening while in care. METHODS This was a retrospective study of all migraine patients seen at the Cincinnati Children's Hospital Headache Center from 09/01/2006 to 12/31/2017, who had at least 1 follow-up visit within 1-3 months of the index visit analyzed. Included data were: age, sex, race, primary ICHD diagnosis, chronic migraine, medication overuse, history of status migrainosus, BMI percentile, headache frequency, headache severity, PedMIDAS score, allodynia, preventive treatment type, lifestyle habits, disease duration, depressive and anxiety symptoms. Clinical worsening was defined as an increase in 4 or more headache days per month between the index visit and the follow-up visit. RESULTS Data for 13,160 visit pairs (index and follow-up), from 5316 patients, were analyzed. Clinical worsening occurred in only 14.5% (1908/13,160), whereas a reduction in headache frequency was observed in 56.8% of visit intervals (7475/13,160), with 34.8% of the intervals (4580/13,160) showing a reduction of 50% or greater. The change in headache frequency was minimal (increase in 0-3 headaches/month) in 28.7% of intervals (3737/13,160). In the multivariable model, the odds of worsening were significantly higher with increasing age, female sex, chronic migraine, status migrainosus, depressive symptoms, higher PedMIDAS scores, and use of nutraceuticals, whereas the odds of worsening were lower for summer visits, caffeine drinkers, higher headache frequencies, and use of pharmaceuticals. CONCLUSIONS The majority of pediatric patients who receive multimodal interdisciplinary care for migraine improve over time. Our findings highlight a set of clinical features that may help in identifying specific factors that may contribute to an unfavorable short-term prognosis.
Collapse
Affiliation(s)
- Serena L Orr
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Abigail Turner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joanne Kacperski
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shannon White
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica Weberding
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mimi N Miller
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- 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
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW The current review presents findings from investigations of migraine in children. The presentation of pediatric migraine, related consequences, and medication treatments are reviewed. RECENT FINDINGS A number of advancements have been made in the study of the presentation, disability, and treatments for migraine in children. However, recent research suggests that not all approaches are equally effective in the treatment of migraine in children. Specifically, a recent study comparing pharmacological interventions found that preventive medications were not statistically more effective than placebo in children. Consistent findings showing clinically meaningful placebo response rates, shorter duration of headaches and other characteristic features (e.g. frontal, bilateral location) have been barriers to the design of randomized clinical trials in children and adolescents with migraine. Better understanding of treatment mechanisms for medication interventions is needed. SUMMARY Several migraine treatments have determined to be effective for use in children but few controlled studies have evaluated the effectiveness of medication treatments. Recent research suggests that preventive medications may not be more effective than placebo. Additional research is needed to evaluate the effectiveness of medication treatment in migraine headache care.
Collapse
|
35
|
Orr SL, Kabbouche MA, O’Brien HL, Kacperski J, Powers SW, Hershey AD. Paediatric migraine: evidence-based management and future directions. Nat Rev Neurol 2018; 14:515-527. [DOI: 10.1038/s41582-018-0042-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
36
|
Irwin SL, Qubty W, Allen IE, Patniyot I, Goadsby PJ, Gelfand AA. Transcranial Magnetic Stimulation for Migraine Prevention in Adolescents: A Pilot Open-Label Study. Headache 2018. [PMID: 29528485 DOI: 10.1111/head.13284] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the feasibility, tolerability, and patient acceptability of single-pulse transcranial magnetic stimulation (sTMS) for migraine prevention in adolescents in an open-label pilot study. BACKGROUND Migraine is common in adolescents and can be disabling. Well tolerated preventative therapies that are safe and effective are needed. METHODS This was an open-label prospective pilot feasibility study of sTMS for migraine prevention in adolescents aged 12-17 years. Participants used sTMS twice daily in a preventative fashion, as well as additional pulses as needed acutely. A 4-week baseline run-in period (weeks 1-4) was followed by a 12-week treatment period. Feasibility was the primary outcome. Secondary outcomes included tolerability and acceptability, as well as the change in headache days, number of moderate/severe headache days, days of acute medication use, and PedMIDAS (headache disability) scores between the run-in period (weeks 1-4) and the third month of treatment (weeks 13-16). RESULTS Twenty-one participants enrolled. Nineteen completed the baseline run-in, and 12 completed the study. Using sTMS proved feasible and acceptable with overall high compliance once treatment administration was streamlined. Initially, for preventive treatment, participants were asked to give 2 pulses, wait 15 minutes, then give 2 additional pulses twice daily. This 15-minute delay proved challenging for adolescents, particularly on school days, and therefore was dropped. Study completion rate went from 4/13 (31%) to 7/8 (88%) once this change was made, P = .024. On average, participants used the device preventively between 22 and 24 days over a 28-day block. There were no serious adverse events. Two participants reported mild discomfort with device use. CONCLUSION sTMS appears to be a feasible, well-tolerated, and acceptable nonpharmacologic preventive treatment for migraine in adolescents. In designing future trials of sTMS for migraine prevention in adolescents, streamlined treatment administration will be essential to minimize drop-out. Efficacy needs to be assessed in a larger trial.
Collapse
Affiliation(s)
- Samantha L Irwin
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - William Qubty
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - I Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Irene Patniyot
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Peter J Goadsby
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA.,NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Amy A Gelfand
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| |
Collapse
|
37
|
Dyadic differences in friendships of adolescents with chronic pain compared with pain-free peers. Pain 2018; 159:1103-1111. [PMID: 29474206 DOI: 10.1097/j.pain.0000000000001191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A multisite cross-sectional study was conducted to examine dyadic friendship features between adolescents with chronic pain (ACP) and their friends compared with non-pain adolescent friendship dyads and the association of these friendship features with loneliness and depressive symptoms. Participants completed a battery of standardized measures to capture friendship features (friendship quality, closeness, and perceived social support from friends) and indices of social-emotional well-being. Sixty-one same sex friendship dyads (122 adolescents) participated; 30 friendship dyads included an adolescent with chronic pain and 52 dyads were female. Adolescents with chronic pain scored significantly higher on measures of loneliness and depressive symptoms compared with all other participants. Hierarchical Multiple Regression analysis revealed that friendship features predicted loneliness and depressive symptoms. Chronic pain predicted loneliness and depressive symptoms above and beyond friendship features. Actor Partner Interdependence Modeling found perceived social support from friends had differing associations on loneliness and depressive symptoms for dyads with a chronic pain member compared with pain-free control dyads. Friendship features were associated with loneliness and depressive symptoms for adolescents, but friendship features alone did not explain loneliness and depressive symptoms for ACP. Further research is needed to understand whether pain-related social support improves loneliness and depressive symptoms for ACP. Furthermore, a more nuanced understanding of loneliness in this population is warranted. Strategies to help ACP garner needed social support from friends are needed to decrease rates of loneliness to improve long-term outcomes.
Collapse
|
38
|
Ormond A, Faux BM, Zickefoose BA, Aden J, Kapunan PE, Roberts TA. Group Education and Multidisciplinary Management for Chronic Headaches Among Adolescents in a Military Treatment Facility: A Retrospective Chart Review. Headache 2018; 58:570-578. [PMID: 29411353 DOI: 10.1111/head.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of group education on the frequency of chronic headaches among adolescents. BACKGROUND Chronic headaches are a common problem among adolescents with significant psychosocial morbidity. Brief education on lifestyle interventions to decrease headache frequency has established benefits among adult patients but is less proven among adolescents. METHODS This study is a chart review examining our experience with a group education program for 155 adolescents, aged 12-17 years old, enrolled in the U.S. military medical system with at least 3 months of chronic headaches who were referred to a headache evaluation clinic. The primary outcome of our study was self-reported number of days with a headache in the previous 30 days based on patient recall. We used a paired samples t-test to measure the change in headache frequency between the frequency reported at the headache class and follow-up more than 6 months after the class. RESULTS Most of the adolescents seen in the program were female (114/155 [73.5%]) and suffered from migraine headaches (108/155 [69.8%]). Severe headache-related disability was reported by 40.6% of subjects (63/155). Subjects reported an average of 19 days with headache during the previous 30 days. Females and patients with higher headache-related disability reported a higher number of days with headache. Participation in the group education was associated with an 11.5 (SD 11.9, P < .001) day decrease in the frequency of headaches during the previous 30 days at follow-up at least 6 months after the class, with largest decline seen in patients with the highest level of migraine-related disability at baseline. CONCLUSION Based on our retrospective chart review study, group education on headache evaluation and lifestyle management has potential as an effective, low-cost intervention for treatment of chronic headaches among adolescents.
Collapse
Affiliation(s)
- Andrew Ormond
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Brian M Faux
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Betty A Zickefoose
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - James Aden
- Department of Biostatistics and Epidemiology, Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Patricia E Kapunan
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Timothy A Roberts
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| |
Collapse
|
39
|
Operto FF, Craig F, Peschechera A, Mazza R, Lecce PA, Margari L. Parenting Stress and Emotional/Behavioral Problems in Adolescents with Primary Headache. Front Neurol 2018; 8:749. [PMID: 29403424 PMCID: PMC5780397 DOI: 10.3389/fneur.2017.00749] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/27/2017] [Indexed: 01/03/2023] Open
Abstract
Primary headache is a frequent and disabling disorder, common among children and adolescents, and it is a painful syndrome often accompanied by functional impairment and associated with emotional and behavior problems. The aim of this study was to investigate parenting stress and emotional/behavioral problems in adolescents affected by primary headache compared with healthy adolescents. The study population consisted of 35 adolescents and a control group of 23 healthy subjects. The assessment included the administration of clinical standardized scales such as Parent Stress Index-Short Form, Pediatric Migraine Disability Assessment Score Questionnaire, and Child Behavior Checklist (CBCL). Headache group and control group did not differ in terms of parenting stress (p = 0.29). On the contrary, headache group showed more internalizing problems (p = 0.023), affective problems (p = 0.01), anxious (p = 0.001), and somatic complaints (p < 0.001) compared with control group. In addition, we found a significant correlation between PSI domains and specific CBCL subscales in the headache group. The findings emphasize the need for expanded intervention in the clinical treatment of pediatric headache, a treatment that may also include the family members. Further research is needed.
Collapse
Affiliation(s)
- Francesca Felicia Operto
- Basic Medical Sciences, Neuroscience and Sense Organs Department, University of the Study of Bari "Aldo Moro", Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Francesco Craig
- Scientific Institute I.R.C.C.S. "Eugenio Medea" - "La Nostra Famiglia", Brindisi, Italy
| | - Antonia Peschechera
- Basic Medical Sciences, Neuroscience and Sense Organs Department, University of the Study of Bari "Aldo Moro", Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Roberta Mazza
- Basic Medical Sciences, Neuroscience and Sense Organs Department, University of the Study of Bari "Aldo Moro", Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Paola Alessandra Lecce
- Basic Medical Sciences, Neuroscience and Sense Organs Department, University of the Study of Bari "Aldo Moro", Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Lucia Margari
- Basic Medical Sciences, Neuroscience and Sense Organs Department, University of the Study of Bari "Aldo Moro", Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| |
Collapse
|
40
|
Amouroux R, Rousseau-Salvador C, Pillant M, Antonietti JP, Tourniaire B, Annequin D. Longitudinal study shows that depression in childhood is associated with a worse evolution of headaches in adolescence. Acta Paediatr 2017; 106:1961-1965. [PMID: 28708256 DOI: 10.1111/apa.13990] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 06/09/2017] [Accepted: 07/11/2017] [Indexed: 01/03/2023]
Abstract
AIM The aim of this study was to examine the course of headache diagnosis, headache frequency, anxiety, comorbid depressive symptoms and school absenteeism in adolescents with migraine and tension-type headaches five years after baseline. METHODS We followed a group of 122 children with a mean age of 10.1 (±1.3) years, with headache from a paediatric migraine centre in Paris who had taken part in a previous study from September 2007 to June 2008. This five-year longitudinal study took place in January to June 2012. The measures that were used included demographic variables, headache diagnosis, headache data and a psychological assessment. RESULTS At the five-year point, about 22% of the children had become headache free, 34% had little to no disability, and 36% had a changed diagnosis. Moreover, a longer history of headache at baseline was associated with a worse evolution of headache at follow-up. Lastly, high depression scores, but not anxiety, were a predictor of more headache disability at follow-up. CONCLUSION High depression scores in childhood were a risk factor that was associated with persistence and worsening of headaches in adolescence. This suggests that mental health assessments should be carried out in paediatric headache pain clinics.
Collapse
Affiliation(s)
- Rémy Amouroux
- Family and Development Research Centre; Institute of Psychology; Lausanne Switzerland
| | - Céline Rousseau-Salvador
- Paediatric Haematology and Oncology; Armand Trousseau Hospital; Assistance Publique des Hôpitaux de Paris (APHP); Paris France
| | | | | | - Barbara Tourniaire
- Paediatric Migraine Centre; Armand Trousseau Hospital, APHP; Paris France
| | - Daniel Annequin
- Paediatric Migraine Centre; Armand Trousseau Hospital, APHP; Paris France
| |
Collapse
|
41
|
Landgraf M, Biebl J, Langhagen T, Hannibal I, Eggert T, Vill K, Gerstl L, Albers L, von Kries R, Straube A, Heinen F. Children with migraine: Provocation of headache via pressure to myofascial trigger points in the trapezius muscle? - A prospective controlled observational study. Eur J Pain 2017; 22:385-392. [DOI: 10.1002/ejp.1127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 01/03/2023]
Affiliation(s)
- M.N. Landgraf
- Department of Paediatric Neurology and Developmental Medicine; Dr. von Hauner Children's Hospital; Ludwig-Maximilians-University; Munich Germany
- German Vertigo and Balance Center (DSGZ); Ludwig-Maximilians-University; Munich Germany
| | - J.T. Biebl
- Department of Paediatric Neurology and Developmental Medicine; Dr. von Hauner Children's Hospital; Ludwig-Maximilians-University; Munich Germany
- German Vertigo and Balance Center (DSGZ); Ludwig-Maximilians-University; Munich Germany
| | - T. Langhagen
- Department of Paediatric Neurology and Developmental Medicine; Dr. von Hauner Children's Hospital; Ludwig-Maximilians-University; Munich Germany
- German Vertigo and Balance Center (DSGZ); Ludwig-Maximilians-University; Munich Germany
| | - I. Hannibal
- Department of Paediatric Neurology and Developmental Medicine; Dr. von Hauner Children's Hospital; Ludwig-Maximilians-University; Munich Germany
- German Vertigo and Balance Center (DSGZ); Ludwig-Maximilians-University; Munich Germany
| | - T. Eggert
- German Vertigo and Balance Center (DSGZ); Ludwig-Maximilians-University; Munich Germany
- Department of Neurology; Campus Grosshadern; Ludwig-Maximilians-University; Munich Germany
| | - K. Vill
- Department of Paediatric Neurology and Developmental Medicine; Dr. von Hauner Children's Hospital; Ludwig-Maximilians-University; Munich Germany
| | - L. Gerstl
- Department of Paediatric Neurology and Developmental Medicine; Dr. von Hauner Children's Hospital; Ludwig-Maximilians-University; Munich Germany
| | - L. Albers
- Institute of Social Pediatrics and Adolescent Medicine; Ludwig-Maximilians-University; Munich Germany
| | - R. von Kries
- Institute of Social Pediatrics and Adolescent Medicine; Ludwig-Maximilians-University; Munich Germany
| | - A. Straube
- German Vertigo and Balance Center (DSGZ); Ludwig-Maximilians-University; Munich Germany
- Department of Neurology; Campus Grosshadern; Ludwig-Maximilians-University; Munich Germany
| | - F. Heinen
- Department of Paediatric Neurology and Developmental Medicine; Dr. von Hauner Children's Hospital; Ludwig-Maximilians-University; Munich Germany
- German Vertigo and Balance Center (DSGZ); Ludwig-Maximilians-University; Munich Germany
| |
Collapse
|
42
|
Abstract
There is little qualitative literature that addresses the adolescent experience of living with headache. The purpose of this study was to determine the dimensions of the health challenge of adolescent headache; the high points, low points, and turning points of living with headache; and the approaches used to resolve the challenge of living with headache. Story theory was used as the qualitative framework to guide data collection, and story inquiry provided the structure for analyzing the data. The Pediatric Migraine Disability Scale (PedMIDAS) quantitatively measured the impact of headaches on daily functioning. Of the 8 participants, 6 reported moderate to severe disability. From the stories, a theme for the complicating health challenge of living with adolescent headache was "an enduring distress manifested by pain, uncertainty, distancing self from family and friends, challenges with school, and not knowing how to resolve." Themes descriptive of the high points, low points, and turning points included "Contentment with school achievement, supportive relationships, and comforting engagement"; "Interruption in pursuing sports/exercise, time with others, and family relationships"; and "A developing realization, through hope and insight, of the possibilities for moving toward resolution." Stories revealed approaches used to resolve the challenge of living with headache, which included self-management through medication, sleep, and transcendence. The findings offer insight into the challenges faced by adolescents with headache and provide evidence of the importance for developing holistic plans of care that address the individual needs of the patient rather than relying on medication management alone.
Collapse
|
43
|
Sampaio Rocha-Filho PA, Hershey AD. Pediatric Migraine Disability Assessment (PedMIDAS): Translation Into Brazilian Portuguese and Cross-Cultural Adaptation. Headache 2017; 57:1409-1415. [DOI: 10.1111/head.13159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Pedro A. Sampaio Rocha-Filho
- Department of Neuropsychiatry; Universidade Federal de Pernambuco (UFPE); Recife Brazil
- Headache Clinic; Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE); Recife Brazil
| | - Andrew D. Hershey
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Headache Center, Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Department of Pediatrics; University of Cincinnati College of Medicine; Cincinnati OH USA
| |
Collapse
|
44
|
Orr SL, Christie SN, Akiki S, McMillan HJ. Disability, Quality of Life, and Pain Coping in Pediatric Migraine: An Observational Study. J Child Neurol 2017; 32:717-724. [PMID: 28393667 DOI: 10.1177/0883073817702025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objective was to examine the relationship between disability, health-related quality of life (HrQoL), and pain coping in pediatric migraineurs. METHOD Eighty-five patients with migraine were recruited from Pediatric Neurology clinics. Participants completed the Pediatric Migraine Disability Assessment Scale, the Pediatric Quality of Life Inventory, the Pain Coping Questionnaire, and the Pain Catastrophizing Scale. Means were compared to published norms using t-tests. Spearman correlations and logistic regression were used to explore the relationships between the variables. RESULTS Mean HrQoL scores were lower than norms for controls and chronically ill pediatric patients ( P < .0001). Patients reported lower mean pain coping scores and higher mean pain catastrophizing scores than norms ( P < .0001). After controlling for age and sex, only the relationship between disability and HrQoL remained significant (OR = 0.91, 95% CI: 0.86-0.95). CONCLUSION Pediatric patients with migraine report lower HrQoL, fewer pain coping strategies and more catastrophizing than controls, while disability is inversely associated with HrQoL.
Collapse
Affiliation(s)
- Serena L Orr
- 1 University of Ottawa, Ottawa, Ontario, Canada.,2 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Salwa Akiki
- 2 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Hugh J McMillan
- 1 University of Ottawa, Ottawa, Ontario, Canada.,2 Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| |
Collapse
|
45
|
Are there any changes in posterior ocular structure parameters in pediatric migraine patients? Eur J Ophthalmol 2017; 27:495-501. [PMID: 27834464 DOI: 10.5301/ejo.5000891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the thickness of the peripapillary retinal nerve fiber layer (RNFL), total macula, macular ganglion cell layer (GCL), inner plexiform layer (IPL), and choroid in pediatric migraine patients and compare the values with healthy subjects. METHODS This observational and cross-sectional study included 40 patients in the migraine group and 40 healthy control subjects. The thickness of the peripapillary RNFL, total macula, GCL, and IPL was analyzed with spectral-domain optic coherence tomography, while choroidal thickness was analyzed with the enhanced depth imaging protocol. All measurements of the migraine patients were taken in the attack-free period. Right eye selected per subject was included in the study. RESULTS There was no significant difference between the 2 groups in age or sex (p>0.05). The peripapillary RNFL thickness was not significantly different between the 2 groups in any quadrant. The total macula, GCL, and IPL thickness were also not significantly different in the 9 separate macular areas defined on the basis of the Early Treatment Diabetic Retinopathy Study (p>0.05). The choroidal thickness at 5 different measurement points was not statistically significantly different between migraine patients during the attack-free period and the healthy subjects (p>0.05). CONCLUSIONS Childhood migraine does not cause changes in posterior ocular structure parameters.
Collapse
|
46
|
Kurt ANC, Aydın A, Demir H, Erel Ö. Headache in children and dynamic thiol/disulfide balance evaluation with a new method. Neurol Sci 2017; 38:1495-1499. [DOI: 10.1007/s10072-017-3004-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/22/2017] [Indexed: 01/03/2023]
|
47
|
Thompson DF, Saluja HS. Prophylaxis of migraine headaches with riboflavin: A systematic review. J Clin Pharm Ther 2017; 42:394-403. [PMID: 28485121 DOI: 10.1111/jcpt.12548] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/05/2017] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Migraine headache is a relatively common, debilitating condition that costs our healthcare system over 78 billion dollars per year. Riboflavin has been advocated as a safe, effective prophylactic therapy for the prevention of migraines. The purpose of this study was to provide a systematic review of the current role of riboflavin in the prophylaxis of migraine headache. METHODS A MEDLINE literature search inclusive of the dates 1966-2016 was performed using the search terms: riboflavin and migraine disorders. Excerpta Medica was searched from 1980 to 2016 using the search terms: riboflavin and migraine. Additionally, Web of Science was searched using the terms riboflavin and migraine inclusive of 1945-2016. Bibliographies of all relevant papers were reviewed for additional citations. We utilized the PRISMA guidelines to select English language, human, clinical trials of riboflavin as a single entity or in combination, review articles, and supporting pharmacokinetic and pharmacogenomic data assessing the efficacy and mechanism of riboflavin therapy in the prophylactic treatment of migraine headache. RESULTS AND DISCUSSION A total of 11 clinical trials reveal a mixed effect of riboflavin in the prophylaxis of migraine headache. Five clinical trials show a consistent positive therapeutic effect in adults; four clinical trials show a mixed effect in paediatric and adolescent patients, and two clinical trials of combination therapy have not shown benefit. Adverse reactions with riboflavin have generally been mild. WHAT IS NEW AND CONCLUSION Riboflavin is well tolerated, inexpensive and has demonstrated efficacy in the reduction of adult patient's migraine headache frequency. Additional data are needed, however, to resolve questions involving pharmacokinetic issues and pharmacogenomic implications of therapy.
Collapse
Affiliation(s)
- D F Thompson
- Pharmaceutical Sciences, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
| | - H S Saluja
- Pharmaceutical Sciences, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
| |
Collapse
|
48
|
Powers SW, Hershey AD, Coffey CS. The Childhood and Adolescent Migraine Prevention (CHAMP) Study: "What Do We Do Now?". Headache 2017; 57:180-183. [PMID: 28128463 DOI: 10.1111/head.13025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/27/2022]
|
49
|
Affiliation(s)
- Yun-Jin Lee
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
| |
Collapse
|
50
|
Abstract
OBJECTIVE To explore the relationship between migraine and anxiety disorders, mood disorders and perceived mental health in a population-based sample of adolescents. METHODS The Canadian Community Health Survey (CCHS) is a cross-sectional health survey sampling a nationally representative group of Canadians. In this observational study, data on all 61,375 participants aged 12-19 years from six survey cycles were analyzed. The relationships between self-reported migraine, perceived mental health, and mood/anxiety disorders were modeled using univariate and multivariate logistic regression. The migraine-depression association was also explored in a subset of participants using the Composite International Diagnostic Interview-Short Form (CIDI-SF) depression scale. RESULTS The odds of migraine were higher among those with mood disorders, with the strongest association in 2011-2 (adjusted odds ratio [aOR]=4.59; 95% confidence interval [CI 95%]=3.44-6.12), and the weakest in 2009-10 (aOR=3.06, CI 95%=2.06-4.55). The migraine-mood disorders association was also significant throughout all cycles, other than 2011-2, when the CIDI-SF depression scale was employed. The odds of migraine were higher among those with anxiety disorders, with the strongest association in 2011-2 (aOR=4.21, CI 95%=3.31-5.35) and the weakest in 2010 (aOR=1.87, CI 95%=1.10-3.37). The inverse association between high perceived mental health and the odds of migraine was observed in all CCHS cycles, with the strongest association in 2011-2 (aOR=0.58, CI 95%=0.48-0.69) and the weakest in 2003-4 (aOR=0.75, CI 95%=0.62-0.91). CONCLUSIONS This study provides evidence, derived from a large population-based sample of adolescents, for a link between migraine and mood/anxiety disorders.
Collapse
|