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Lorente-Piera J, Pérez-Fernández N, Blanco-Pareja M, Manrique-Huarte R, Michael Larenas P, Serra V, Manrique M. Clinical Profile, Trends, and Management in Pediatric Patients with Audiovestibular Disorders: Can We Predict Emotional Disability in Pediatric Patients with Episodes of Vertigo and Dizziness? Audiol Res 2024; 14:701-713. [PMID: 39194415 DOI: 10.3390/audiolres14040059] [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: 07/16/2024] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Audiovestibular disorders in childhood occur with considerable frequency. However, the difficulty of obtaining medical history, the nonspecificity of symptoms, and the lack of cooperation during complementary tests often contribute significantly to diagnostic biases, attributing clinical presentations to psychosomatic disorders. The objectives of this work are, firstly, to characterize, from an auditory and vestibular perspective, the most frequent causes of vertigo in childhood and a possible relationship with emotional symptoms. On the other hand, to propose the usefulness of the MSSQ-Short questionnaire as a predictive variable in the evolution of children diagnosed with recurrent vertigo of childhood (RVC). METHODS An observational cross-sectional study was designed with retrospective data collection at three tertiary hospitals. RESULTS Among the 117 patients recruited between 2016 and 2024, 32 patients (27.35%) were diagnosed with an anxious-depressive syndrome prior to audiovestibular testing. The mean age was 11.19 ± 5.61 years and the most frequent final diagnoses were vestibular migraine (VM) with 41.03% and RVC with 23.93%. Patients with VM, compared with RVC, are approximately 1.12 times more likely to have psychosomatic pathology (CI 0.39 to 3.25). The most sensitive and frequently altered test was VEMPS (39.32%), with statistical significance in VM and otic capsule dehiscence, while regarding the MSSQ-Short questionnaire, the linear regression of 0.28 indicates an increase in clinical duration with high questionnaire scores. CONCLUSIONS Vestibular disorders causing dizziness and vertigo are challenging to diagnose, often due to lack of cooperation and/or symptom nonspecificity. A thorough medical history and complementary tests, including audiovestibular and imaging studies, are advisable, thus avoiding systematically attributing children's complaints to other psychosomatic disorders.
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Affiliation(s)
- Joan Lorente-Piera
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | | | - Melissa Blanco-Pareja
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 28027 Madrid, Spain
| | - Raquel Manrique-Huarte
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Pia Michael Larenas
- Department of Otorhinolaryngology, Hospital Clínico de la Universidad de Chile, Santiago 8380453, Chile
| | - Valeria Serra
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Manuel Manrique
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
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Naeem S, Lozano JM, Ruiz Castaneda AM, Lowe D. Diphenhydramine and Migraine Treatment Failure in Pediatric Patients Receiving Prochlorperazine. Pediatr Emerg Care 2024; 40:e169-e173. [PMID: 38718751 DOI: 10.1097/pec.0000000000003202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
OBJECTIVES The objectives are to determine whether diphenhydramine coadministered with prochlorperazine versus prochlorperazine only is associated with a difference in the risk of migraine treatment failure, as measured by the need for additional therapy, hospitalization rates, and 72-hour return rates, and to compare extrapyramidal adverse effects between groups. METHODS Retrospective cohort of patients aged 7 to 18 years treated in the emergency department for migraines using prochlorperazine with or without diphenhydramine between 2013 and 2019. Patients were included if they had International Classification of Diseases, Ninth or Tenth Revision, codes for migraine or unspecified headache and were treated with prochlorperazine as part of their initial migraine therapy. Data collected included demographics, medications administered, pain scores, neuroimaging, disposition, return visits, and documentation of extrapyramidal adverse effects. Multivariable logistic regression was used to estimate the association between diphenhydramine coadministration and each of the outcomes. RESULTS A total of 1683 patients were included. Overall, 13% required additional therapy with a 16.7% admission rate and a 72-hour return rate of 5.3%. There was no association between initial treatment with diphenhydramine and the odds of additional therapy (adjusted odds ratio [aOR], 0.74 [95% confidence interval {CI}, 0.53-1.03]), admission rates (aOR, 1.22 [95% CI, 0.89-1.67]), or return visit rates (aOR, 0.91 [95% CI, 0.55-1.51]). Extrapyramidal adverse effects occurred in 2.4% of patients in the prochlorperazine group and 0% in the prochlorperazine with diphenhydramine group. CONCLUSIONS There was no association between diphenhydramine coadministration and the need for additional therapy, 72-hour return visit rates or admission rates. Extrapyramidal effects did not occur in patients treated with diphenhydramine.
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Affiliation(s)
- Sobia Naeem
- From the Department of Pediatric Emergency Medicine, Nicklaus Children's Hospital
| | - Juan M Lozano
- Department of Medical and Population Health Science Research, Florida International University Herbert Wertheim College of Medicine
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Ayulo MA, Jenkins S, Le T, Tripathi S. Effectiveness of Lidocaine Infusion Versus Valproate Infusion for Pediatric Status Migrainosus. Hosp Pediatr 2024; 14:541-547. [PMID: 38860308 DOI: 10.1542/hpeds.2023-007593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE To compare the efficacy (as measured by time to resolution of pain) and safety of valproate infusion and lidocaine infusion in the treatment of pediatric status migrainosus. METHODS We conducted a single-center retrospective cohort study from March 2014 to June 2021 evaluating children and adolescents who received a lidocaine or sodium valproate infusion for the treatment of status migrainosus. During the study period, lidocaine infusion was exclusively used before March 2016, whereas sodium valproate infusion was exclusively used afterward. RESULTS A total of 31 patients received lidocaine and 63 received sodium valproate infusion. Patients in the lidocaine group achieved significantly faster control of pain with median hours to pain free of 11.7 (interquartile range, 3.8-32.3) hours compared with 43.4 (interquartile range 13.8-68.7) hours in the valproate group (P = .002). At discharge, 21 of 31 (67.7%) of patients receiving lidocaine were pain-free compared with 26 of 59 (44.1%) of patients receiving valproate (P = .03). There were significantly more infusion interruptions of valproate compared with lidocaine for various patient-related factors (16/63, 25.4% vs 1/31, 3.2%; P = .009). More adverse effects were observed with valproate (42/63, 67%) compared with lidocaine (1/31, 3.2%; P < .001). The significant difference in hours to pain control persisted after adjustment for sex, race, age, BMI, presence of comorbidities, and pain score at admission. All patients in both groups completed the infusions and were discharged from the hospital. CONCLUSIONS Intravenous lidocaine infusion is associated with superior pain control and a better safety profile compared with intravenous sodium valproate infusion in status migrainosus.
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Affiliation(s)
| | - Sharaya Jenkins
- Department of Nursing, Department of Pediatrics, Fountain Valley Regional Hospital and Medical Center, Fountain Valley, California
| | | | - Sandeep Tripathi
- Department of Pediatrics, University of Illinois College of Medicine at Peoria/OSF HealthCare, Children's Hospital of Illinois at Peoria, Illinois
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Sørensen HM, Rochfort KD, Maye S, MacLeod G, Loscher C, Brabazon D, Freeland B. Bioactive Ingredients from Dairy-Based Lactic Acid Bacterial Fermentations for Functional Food Production and Their Health Effects. Nutrients 2023; 15:4754. [PMID: 38004148 PMCID: PMC10675170 DOI: 10.3390/nu15224754] [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: 10/03/2023] [Revised: 10/27/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
Lactic acid bacteria are traditionally applied in a variety of fermented food products, and they have the ability to produce a wide range of bioactive ingredients during fermentation, including vitamins, bacteriocins, bioactive peptides, and bioactive compounds. The bioactivity and health benefits associated with these ingredients have garnered interest in applications in the functional dairy market and have relevance both as components produced in situ and as functional additives. This review provides a brief description of the regulations regarding the functional food market in the European Union, as well as an overview of some of the functional dairy products currently available in the Irish and European markets. A better understanding of the production of these ingredients excreted by lactic acid bacteria can further drive the development and innovation of the continuously growing functional food market.
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Affiliation(s)
- Helena Mylise Sørensen
- School of Biotechnology, Dublin City University, D09 DX63 Dublin, Ireland; (C.L.); (B.F.)
- I-Form, Advanced Manufacturing Research Centre, Dublin City University, D09 DX63 Dublin, Ireland;
| | - Keith D. Rochfort
- School of Nursing, Psychotherapy and Community Health, Dublin City University, D09 DX63 Dublin, Ireland;
| | - Susan Maye
- Dairygold Co-Operative Society Limited, Clonmel Road, Co. Cork, P67 DD36 Mitchelstown, Ireland; (S.M.); (G.M.)
| | - George MacLeod
- Dairygold Co-Operative Society Limited, Clonmel Road, Co. Cork, P67 DD36 Mitchelstown, Ireland; (S.M.); (G.M.)
| | - Christine Loscher
- School of Biotechnology, Dublin City University, D09 DX63 Dublin, Ireland; (C.L.); (B.F.)
| | - Dermot Brabazon
- I-Form, Advanced Manufacturing Research Centre, Dublin City University, D09 DX63 Dublin, Ireland;
| | - Brian Freeland
- School of Biotechnology, Dublin City University, D09 DX63 Dublin, Ireland; (C.L.); (B.F.)
- I-Form, Advanced Manufacturing Research Centre, Dublin City University, D09 DX63 Dublin, Ireland;
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Börner-Schröder C, Lang M, Urban G, Zaidenstadt E, Staisch J, Hauser A, Hannibal I, Huß K, Klose B, Lechner MF, Sollmann N, Landgraf MN, Heinen F, Bonfert MV. Neuromodulation in Pediatric Migraine using Repetitive Neuromuscular Magnetic Stimulation: A Feasibility Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1764. [PMID: 38002855 PMCID: PMC10670480 DOI: 10.3390/children10111764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Migraine has a relevant impact on pediatric health. Non-pharmacological modalities for its management are urgently needed. This study assessed the safety, feasibility, acceptance, and efficacy of repetitive neuromuscular magnetic stimulation (rNMS) in pediatric migraine. A total of 13 patients with migraine, ≥6 headache days during baseline, and ≥1 myofascial trigger point in the upper trapezius muscles (UTM) received six rNMS sessions within 3 weeks. Headache frequency, intensity, and medication intake were monitored using headache calendars; headache-related impairment and quality of life were measured using PedMIDAS and KINDL questionnaires. Muscular involvement was assessed using pressure pain thresholds (PPT). Adherence yielded 100%. In 82% of all rNMS sessions, no side effects occurred. All participants would recommend rNMS and would repeat it. Headache frequency, medication intake, and PedMIDAS scores decreased from baseline to follow-up (FU), trending towards statistical significance (p = 0.089; p = 0.081, p = 0.055). A total of 7 patients were classified as responders, with a ≥25% relative reduction in headache frequency. PPT above the UTM significantly increased from pre- to post-assessment, which sustained until FU (p = 0.015 and 0.026, respectively). rNMS was safe, feasible, well-accepted, and beneficial on the muscular level. The potential to reduce headache-related symptoms together with PPT changes of the targeted UTM may underscore the interplay of peripheral and central mechanisms conceptualized within the trigemino-cervical complex.
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Affiliation(s)
- Corinna Börner-Schröder
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Magdalena Lang
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Giada Urban
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Erik Zaidenstadt
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Jacob Staisch
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Ari Hauser
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Iris Hannibal
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Kristina Huß
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Birgit Klose
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Matthias F. Lechner
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany;
- TUM-Neuroimaging Center, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Mirjam N. Landgraf
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
| | - Michaela V. Bonfert
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics, Dr. Von Hauner Children’s Hospital, LMU University Hospital, LMU Munich, 80337 Munich, Germany; (C.B.-S.); (I.H.); (M.N.L.); (F.H.)
- LMU Center for Children with Medical Complexity-iSPZ Hauner, LMU University Hospital, LMU Munich, 80337 Munich, Germany
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Ombashi S, Tsangaris E, Heeres AG, van Roey V, Neuteboom RF, van Veelen-Vincent MLC, Jansson K, Mathijssen IMJ, Klassen AF, Versnel SL. Quality of life in children suffering from headaches: a systematic literature review. J Headache Pain 2023; 24:127. [PMID: 37718449 PMCID: PMC10506203 DOI: 10.1186/s10194-023-01595-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/12/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Headaches are the most common complaints among pediatric populations. Determining the cause and appropriate treatment for headaches may be challenging and costly, and the impact of headaches on the lives of patients and their families is not well understood. OBJECTIVE A systematic literature review was conducted to examine what PROMs are currently used, and to identify quality of life (QoL) concepts important to children suffering from headaches and any known determinants of QoL. METHODS Embase, Medline, Web of Science, CINAHL, EBSCOhost, PsychINFO, Cochrane CENTRAL and Google Scholar were searched from their inception through to June 2021. Studies investigating QoL, using a validated outcome measure in pediatric patients with headaches, were included. Relevant studies were identified through title and abstract screening and full text review by two independent reviewers. A citation review of included studies was performed. QoL concepts were extracted from the outcome measures that were used in each study to develop a preliminary conceptual model of QoL in children suffering from headaches. Determinants of QoL were also identified and categorized. RESULTS A total of 5421 studies were identified in the search. Title and abstract screening resulted in the exclusion of 5006 studies. Among the 415 studies included for full text review, 56 were eligible for final analysis. A citation review resulted in the addition of five studies. Most studies were conducted in high-income countries and included a patient-sample accordingly (n = 45 studies). Sixteen different PROMs were identified in the included studies, of which the PedsQL was used the most often (n = 38 studies). The most common health concepts reported were physical functioning (n = 113 items), social and psychological wellbeing (N = 117, n = 91 resp.). Twenty-five unique determinants of QoL were extracted from the included studies. CONCLUSION There is a need for a condition-specific PROM to facilitate the measurement of QoL outcomes in the pediatric headache population. A conceptual model was developed based on the findings from the health concepts. Findings from this review could be used for future qualitative interviews with pediatric patients with headaches to elicit and refine important QoL concepts.
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Affiliation(s)
- S Ombashi
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - E Tsangaris
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A G Heeres
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - V van Roey
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - R F Neuteboom
- Children's Brain Lab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M L C van Veelen-Vincent
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Children's Brain Lab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Neurosurgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K Jansson
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Reconstructive Surgery and Craniofacial Surgery, Stockholm, Karolinska University Hospital, Stockholm, Sweden
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Children's Brain Lab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- European Reference Network for Craniofacial Anomalies and Ear- Nose- and Throat Disorders, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Children's Brain Lab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Chanchlani R, Agrawal A, Janjua D, Hafsa SN. The Efficacy of Different Triptans for the Treatment of Acute Headache in Pediatric Migraine: A Systematic Review. Indian Pediatr 2023; 60:663-671. [PMID: 37209053 DOI: 10.1007/s13312-023-2968-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
BACKGROUND Serotonin receptors 5-HT1B and 5-HT1D in the cerebral arteries are activated by the 5-hydroxytryptophan agonists (triptans) to relieve the discomfort associated with migraines. Even though triptans are often used to treat acute migraines, there is some debate over their effectiveness. OBJECTIVE Our systematic review aimed to evaluate the effectiveness of triptans for acute treatment of migraine in young individuals. METHODS Utilizing the databases of Google Scholar, Cochrane Library, and PubMed, a literature search was conducted, and all papers published till July 2022 were included. This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. In addition to the Boolean operators AND, OR, and NOT, the following descriptive terms were also used: "Triptans," "Pediatric Migraine," "Migraine disorders," "Headache," "Children," and "Adolescent." RESULTS A total of 1047 studies were identified, and 25 articles were finally included in the study. 17 of them were RCTs while the remaining were non-randomized trials. Most studies recruited participants aged between 12-17 years. Among 25 studies, 7 reported sumatriptan use, 3 assessed a combination of sumatriptan and naproxen, 4 were on almotriptan, 1 on eletriptan, 6 on rizatriptan, and 4 on zolmitriptan use. CONCLUSION We found that rizatriptan (good tolerability profile with a dose of 5 mg) and sumatriptan (nasal spray, 10 mg and 20 mg) had higher efficiency as compared to other triptans. Regardless of type or dose, all triptans are generally well tolerated by patients, but a few adverse effects such as light-headedness (sumatriptan), nasopharyngitis, and, muscular spasms (sumatriptan/ naproxen), somnolence, and dry mouth (rizatriptan), and dizziness (zolmitriptan group) were reported with the triptans.
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Affiliation(s)
- Roshan Chanchlani
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
| | - Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh. Correspondence to: Dr Amit Agrawal, 28, Ravidas Nagar, Near Nizamuddin Colony, Bhopal, Madhya Pradesh 462 023.
| | - Dalwinder Janjua
- Department of Neonatology, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Shaik Nida Hafsa
- Department of Otorhinolaryngology, Rajiv Gandhi University of Health Sciences, Karnataka, India
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Muacevic A, Adler JR, Madabushi J. Off-Label Cyproheptadine in Children and Adolescents: Psychiatric Comorbidities, Interacting Variables, Safety, and Risks of Hepatotoxicity. Cureus 2023; 15:e33745. [PMID: 36788882 PMCID: PMC9922522 DOI: 10.7759/cureus.33745] [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: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
Cyproheptadine is a widely prescribed first-generation antihistamine, and due to its unique chemical structure, it has a popular off-label choice for a range of clinical conditions. Its efficacy is widely debated in the literature, but there are reports of hepatotoxicity as a rare adverse effect. Its benefits in migraine prophylaxis and appetite stimulation also underscore a highly overlapping clinical pathway that requires additional assessment and evaluation. The evidence suggests a baseline metabolic profile before initiation and assessment for co-occurring mental health conditions may improve overall response with evidence-based mental health interventions.
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Khayata MJ, Farley S, Davis JK, Hornik CP, Reeve BB, Rikhi A, Gelfand AA, Szperka CL, Kessel S, Pezzuto T, Hammett A, Lemmon ME. Beyond pain control: Outcome and treatment preferences in pediatric migraine. Headache 2022; 62:588-595. [PMID: 35524445 PMCID: PMC9133183 DOI: 10.1111/head.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/09/2022] [Accepted: 03/30/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of this study was to describe treatment preferences and perceived quality of existing outcome measures among children and adolescents with migraine and their caregivers. BACKGROUND Across disciplines, there is increasing recognition of the value of direct input from stakeholders. Little empirical work has been done to determine what outcomes matter most to pediatric patients with migraine and their caregivers. METHODS In this qualitative study, we recruited participants from the multicenter, prospective Pediatric Migraine Registry. We used stratified purposive sampling to recruit children and adolescents of varied ages and headache frequency. Patients with migraine and their caregivers completed semistructured interviews targeting treatment preferences and perceived quality of existing outcome measures. Emergent themes and subthemes were identified using conventional content analysis. RESULTS Thirty dyads of children/adolescents and their caregivers were enrolled and completed 59 interviews (n = 29 children/adolescent interviews and n = 30 caregiver interviews). Three themes emerged. (1) Symptom relief: Looking beyond headache resolution: Participants described the value of outcomes in addition to pain relief, including a reduction in migraine intensity and improvement in non-pain symptoms. (2) Trade-offs between side effects and relief: Participants described cost-benefit analyses that can occur with headache treatment and acknowledged the impact of drug side effects on daily life and medication adherence. (3) Child-centered treatment: Participants described medication attributes salient to the pediatric context, including age-appropriate routes of administration and adequate safety data. CONCLUSIONS Children, adolescents, and caregivers impacted by migraine value outcomes in addition to traditionally studied migraine endpoints. Participants valued decreased pain severity, even in the absence of pain resolution. Participants also prioritized the absence of side effects and key medication attributes, including fast onset and age-appropriate routes of administration. These results highlight an opportunity to design patient-centered clinical trials, develop drugs, and support product labeling that align with the outcomes valued most by children and adolescents with migraine and their caregivers.
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Affiliation(s)
- Matthew J. Khayata
- Department of Pediatrics Duke University School of Medicine Durham North Carolina USA
| | - Samantha Farley
- School of Social Work University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
- Fuqua School of Business Duke University Durham North Carolina USA
| | - J. Kelly Davis
- Fuqua School of Business Duke University Durham North Carolina USA
| | - Christoph P. Hornik
- Department of Pediatrics Duke University School of Medicine Durham North Carolina USA
- Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina USA
| | - Bryce B. Reeve
- Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina USA
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
| | - Aruna Rikhi
- Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina USA
| | - Amy A. Gelfand
- Department of Neurology UCSF Child & Adolescent Headache Program San Francisco California USA
| | - Christina L. Szperka
- Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | | | - Tara Pezzuto
- Nemours Neurology Headache Program Alfred I. Dupont Hospital for Children Wilmington Delaware USA
| | - Alex Hammett
- Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina USA
| | - Monica E. Lemmon
- Department of Pediatrics Duke University School of Medicine Durham North Carolina USA
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
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10
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Abstract
OBJECTIVE Migraine is a chronic neurological disease involving the brain and its vasculature, typically characterized by recurrent attacks of moderate or severe throbbing headache, accompanied by sensitivity to light and sound, and associated with nausea, vomiting, and inability to move due to worsening of pain. About 30% of migraineurs have some type of aura, most often visual. Migraine attacks, if untreated or suboptimally treated, usually result in significant disability, requiring bed rest and resulting in poor quality of life. Increased frequency of attacks and overuse of acute care medication are significant risks for chronification, resulting in the transformation of episodic migraine into chronic migraine. We aim to review most acute care treatments for migraine. METHODS Current treatment options for migraine attacks were reviewed from the selected literature and combined with our clinical experience. RESULTS Current acute treatment options for migraine attacks include over-the-counter analgesics, at times combined with caffeine, nonsteroidal anti-inflammatory medications, opioids, and migraine-specific medications such as triptans and ergots. In the near future, we will probably have 3 gepants (small-molecule calcitonin gene-related peptide [CGRP] receptor antagonists). The first one was just approved in the United States. A ditan acting as a stimulator of 5-HT1F receptors, was also just approved by the FDA. Stimulation of the trigeminal, vagal, occipital, and even upper arm peripheral nerves through electrical nerve stimulation devices and magnetic stimulation devices are available as alternative, nondrug treatment options. Several devices have already been FDA-allowed for treatment in the United States and/or approved elsewhere, and others will follow soon. Behavioral medicine techniques such as biofeedback training and mindfulness have been available for some time and are often helpful. CONCLUSION A wide variety of acute care options to treat migraine are available, and others will soon be and will herein be described in further detail. Some medications have been approved by regulatory authorities in countries other than the United States, and some devices have been given a CE Mark in Europe.
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Affiliation(s)
- Spingos Konstantinos
- Corfu Headache Clinic (SK), Corfu, Greece; Headache Clinic (VM), Mediterraneo Hospital, Glyfada, Greece and Glyfada Headache Clinic, Glyfada, Greece; and the David Geffen School of Medicine at UCLA in Los Angeles (RA), Los Angeles, California; Past President of the International Headache Society (IHS), Founder and Director-Emeritus of the New England Center for Headache, Stamford, Connecticut
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11
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Reidy BL, Peugh J, Hershey AD, Coffey CS, Chamberlin LA, Ecklund DJ, Klingner EA, Yankey JW, Korbee LL, Porter LL, Kabbouche MA, Kacperski J, Powers SW. Trajectory of treatment response in the child and adolescent migraine prevention (CHAMP) study: A randomized clinical trial. Cephalalgia 2021; 42:44-52. [PMID: 34404270 DOI: 10.1177/03331024211033551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Identify preventive medication treatment response trajectories among youth participating in the Childhood and Adolescent Migraine Prevention study. METHODS Data were evaluated from 328 youth (ages 8-17). Childhood and Adolescent Migraine Prevention study participants completed headache diaries during a 28-day baseline period and a 168-day active treatment period during which youth took amitriptyline, topiramate, or placebo. Daily headache occurrence trajectories were established across baseline and active treatment periods using longitudinal hierarchical linear modeling. We tested potential treatment group differences. We also compared final models to trajectory findings from a clinical trial of cognitive behavioral therapy plus amitriptyline for youth with chronic migraine to test for reproducibility. RESULTS Daily headache occurrence showed stability across baseline. Active treatment models revealed decreases in headache frequency that were most notable early in the trial period. Baseline and active treatment models did not differ by treatment group and replicated trajectory cognitive behavioral therapy plus amitriptyline trial findings. CONCLUSIONS Replicating headache frequency trajectories across clinical trials provides strong evidence that youth can improve quickly. Given no effect for medication, we need to better understand what drives this clinically meaningful improvement. Results also suggest an expected trajectory of treatment response for use in designing and determining endpoints for future clinical trials.Trial Registration. ClinicalTrials.gov Identifier: NCT01581281.
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Affiliation(s)
- Brooke L Reidy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher S Coffey
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Leigh A Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dixie J Ecklund
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Elizabeth A Klingner
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Jon W Yankey
- Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Leslie L Korbee
- Academic Regulatory & Monitoring Services, LLC, Cincinnati, OH, USA
| | - Linda L Porter
- National Institute of Neurological Disorders and Stroke, Bethesda MD, USA
| | - Marielle A Kabbouche
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joanne Kacperski
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Headache Center, Cincinnati, OH, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Headache Center, Cincinnati, OH, USA
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12
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Riviello JJ, Erklauer J. Evidence-Based Protocols in Child Neurology. Neurol Clin 2021; 39:883-895. [PMID: 34215392 DOI: 10.1016/j.ncl.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Medical care has become more complex as the scientific method has expanded medical knowledge. Medicine is also now practiced across different medical systems of varying complexity, and creating standard treatment guidelines is one way of establishing uniform treatment across these systems. The creation of guidelines ensures the delivery of quality medical care and improved patient outcomes. Evidence-based medicine is the application of scientific research to produce these treatment guidelines. This article shall focus on the current treatment guidelines used for inpatient pediatric neurology.
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Affiliation(s)
- James J Riviello
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA.
| | - Jennifer Erklauer
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA; Section of Pediatric Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA
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13
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Kilic B. Evaluation of the Etiology, Clinical Presentation, Findings and Prophylaxis of Children with Headache. SISLI ETFAL HASTANESI TIP BULTENI 2021; 55:128-133. [PMID: 33935547 PMCID: PMC8085460 DOI: 10.14744/semb.2019.36604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/15/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES A headache is prevalent in childhood and constitutes a significant part of outpatient applications. This study aimed to evaluate the results of etiology, clinical features, examination results, prophylactic treatment and follow-up in patients with a headache. METHODS Between January 2017 and December 2018, the files of the patients with the complaint of headache were reviewed retrospectively in this study. A headache was classified according to the International Headache Society (IHS) criteria. RESULTS In this study, 350 patients aged between 3-17 years old and the mean age of 11.2±2.7 with a headache were included; 212 (60.6%) of them was female and 138 (39.4%) of them was male. The rate of a primary headache was higher in females than in males (p=0.004). The headache causes were a migraine in 51.1%, tension-type headache in 32.3%, secondary in 13.4%, and not classified in 3.1%. The mean age of the patients with a primary headache was significantly higher than patients with a secondary headache (p<0.001). The most common trigger factor was insomnia (52.7%). Abnormal physical/neurological signs and symptoms were detected in 17 (9.49%) patients. Cranial magnetic resonance imaging (MRI) examination was performed in 121 (34.5%) patients. Abnormal findings were found in 35 (28.9%) of these. In this study, 33 patients underwent electroencephalography (EEG); none of the had an epileptiform abnormality. Flunarizine (23.2%) and cyproheptadine (7.5%) were the most administered prophylactic treatments. It was observed that all patients who had prophylaxis and who had come to control had a significant decrease in headaches. CONCLUSION The cause of childhood headaches is mostly migraine and tension-type headache. As long as there is no abnormality in the history and neurological examination, neuroimaging studies are not required in the routine evaluation of patients with a headache. Prophylactic treatment increases the quality of life in selected cases.
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Affiliation(s)
- Betul Kilic
- Department of Pediatric Neurology, University of Health Sciences Turkey Faculty of Medicine, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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14
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Das R, Qubty W. Retrospective Observational Study on Riboflavin Prophylaxis in Child and Adolescent Migraine. Pediatr Neurol 2021; 114:5-8. [PMID: 33189027 DOI: 10.1016/j.pediatrneurol.2020.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND We evaluated the efficacy of riboflavin in pediatric migraineurs. METHODS A retrospective observational study was performed on 42 patients (aged six to 18 years) with migraine who were evaluated from January to December 2019 at Dell Children's Medical Center in Austin, Texas. Weight-based dosing of riboflavin was recommended for migraine prevention. Descriptive statistics were used to study the population demographics. Nonparametric tests were used for inferential statistics to study the effect of riboflavin on headache frequency, intensity, and duration. RESULTS Patients treated with riboflavin had a significant reduction in headache days per month (frequency) at the first follow-up visit at 2 to 4 months (T1) (11.07 ± 10.52 days) compared with the baseline T0 (21.90 ± 9.85 days); P < 0.001 in regard to the primary outcome in 42 patients (mean age, 13.38 ± 3.38). Mean headache intensity decreased from 8.85 (±6.41; T0) to 2.30 (±2.51; T1); P < 0.001 on a 0 to 10 scale. The headache duration also reduced significantly from 18.23 ± 17.07 hours (T0) to 10.18 ± 10.49 hours (T1); P = 0.001. There was a positive correlation between riboflavin efficacy and reduced use of acute medications (rs = 0.304; P = 0.05). Riboflavin was useful in reducing the frequency and intensity in two patients with new daily persistent headache. CONCLUSIONS Patients treated with riboflavin had a reduction in headache frequency, use of acute medications, and days of school missed. Riboflavin prophylaxis also reduced migraine intensity and duration. Riboflavin is recommended as a safe, inexpensive, and effective nutraceutical in the treatment of pediatric migraine.
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Affiliation(s)
- Rakhi Das
- Pediatric Headache Program, Department of Neurology, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - William Qubty
- Pediatric Headache Program, Department of Neurology, The University of Texas at Austin Dell Medical School, Austin, Texas.
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15
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Abstract
The purpose of the Research to Practice column is to review and critique current research articles that directly affect the practice of the advanced practice nurse (APN) in the emergency department. This review examines the findings of M. from their article, "Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society." The authors completed an extensive literature review and created eight recommendations for the acute treatment of pediatric migraine focusing on medication selection, dosing, patient education, and patient counseling. By applying the evidence-based guidelines presented in this study, the urgent care or emergency department APN can confidently recognize and treat acute migraine symptoms and reduce patient risks from unnecessary testing and overuse of acute migraine medications.
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16
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McVige JW, Hogan RM, Shanahan CM, Amend DL, Ferger SM. An Open-Label Study Evaluating the Pharmacokinetics and Safety of Diclofenac Potassium for Oral Solution for the Acute Treatment of MWA or MWoA in Pediatric Participants. Headache 2020; 60:1939-1946. [PMID: 32767766 DOI: 10.1111/head.13922] [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: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the pharmacokinetics, safety, and tolerability of a single 50-mg oral dose of diclofenac potassium for oral solution (OS) in a pediatric cohort with a diagnosis of episodic migraine; the 3-month safety trial following an outpatient dosing period was also evaluated. BACKGROUND Children and adolescents often experience migraine pain that is poorly controlled, which may affect their emotional and psychological well-being. Diclofenac potassium for OS is approved for the treatment of migraine with aura (MWA) or migraine without aura (MWoA) in adults 18 years of age or older. It is formulated in a soluble buffered powder that provides more rapid absorption than the tablet formulations of diclofenac potassium. In a randomized, double-blind, crossover trial, more adult patients were pain-free at 2 hours post-dose following treatment with diclofenac potassium for OS than those who received the diclofenac tablet formulation or placebo. METHODS This was a Phase 4 open-label study that took place at 2 US sites. Participants 12-17 years of age with a diagnosis of episodic MWA or MWoA for ≥3 months and ≤14 headaches per month were enrolled in the study. Participants received one 50-mg dose of diclofenac potassium for OS under fasted conditions on day 1. Blood samples were collected for PK analysis within 15 minutes pre-dose and at 5, 10, 15, 20, 30, 40, and 60 minutes post-dose, and at 2, 4, and 6 hours post-dose. Safety evaluations were performed after the initial dose and at the end of study on day 90; adverse events were monitored throughout the study. After completing the PK assessments, participants were given a 3-month supply (27 packets) of diclofenac potassium for OS (50-mg doses) for their migraine attacks. Participants were advised to take diclofenac potassium for OS at the onset of a migraine. They were told to take no more than 2 doses daily and not to use it more than 3 days/week. RESULTS Twenty-five participants completed the study; 84% were females and 96% were white or Caucasian, with a mean age of 15.5 years and a mean weight of 63.1 kg. Diclofenac was rapidly absorbed with a median time to maximum concentration of 15 minutes and a mean peak plasma concentration of 1412 (±846.2) ng/mL. Diclofenac had a half-life of 66.8 (±9.2) minutes. The mean area under the concentration-time curve from zero to the last measurable time point was 82,920.0 (±25,327.6) minutes × ng/mL, and the mean area under the concentration-time curve from time zero to infinity was 84,388.8 (±25,993.6) minutes × ng/mL. Participants took the study drug an average of 10 times over 79 days, with an overall total drug exposure of 506 mg. No deaths or discontinuations due to an AE were reported during the study. The most frequently reported treatment emergent adverse events were arthralgia and motion sickness, each of which occurred in 2 (8%) of the participants. CONCLUSIONS Diclofenac potassium for OS exhibited a favorable pharmacokinetic and safety profile in 12- to 17-year-old patients with a diagnosis of episodic MWA or MWoA.
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Affiliation(s)
| | - Rebecca M Hogan
- Headache Clinic, Dent Neurologic Institute, Amherst, NY, USA
| | | | - Diane L Amend
- gRED Clinical Operations, Depomed, Inc, Newark, CA, USA
| | - Shawn M Ferger
- Department of Administration, Dent Neurologic Institute, Amherst, NY, USA
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17
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Affiliation(s)
- Irene Patniyot
- Texas Children's Hospital Pediatric Headache Clinic, Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston
| | - William Qubty
- Pediatric Headache Center, Dell Medical School, Department of Neurology, University of Texas at Austin, Austin
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18
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Yamanaka G, Suzuki S, Takeshita M, Go S, Morishita N, Takamatsu T, Daida A, Morichi S, Ishida Y, Oana S, Nara S, Shimura M, Nishimata S, Kawashima H. Effectiveness of low-dose riboflavin as a prophylactic agent in pediatric migraine. Brain Dev 2020; 42:523-528. [PMID: 32336482 DOI: 10.1016/j.braindev.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Riboflavin may prevent migraine episodes; however, there is limited evidence of its effectiveness in pediatric populations. This study investigated the effectiveness of riboflavin and clinical predictors of response in children with migraines. METHODS We retrospectively reviewed data from 68 Japanese children with migraines, of whom 52 also exhibited another type of headache. Patients received 10 or 40 mg/day of riboflavin. We evaluated the average migraine frequency per month as a baseline and after 3 months of riboflavin therapy to determine the effectiveness and clinical predictors of response. RESULTS The frequency of migraine episodes was significantly lower at 3 months than at baseline (median, [interquartile range], 5.2 (3-7) vs. 4.0 (2-5); p < 0.01). Twenty-five patients (36.7%) showed 50% or greater reduction in episode frequency (responders), while 18 (26.5%) showed a 25%-50% reduction. We compared responders (n = 25) and non-responders (n = 43) and found no significant differences in sex, familial history, riboflavin dose, migraine type (i.e., presence or absence of aura), age at headache onset, or age at consultation. However, non-responders were more likely to have co-morbid non-migraine headaches (odds ratio, 4.11; 95% confidence interval [CI], 1.27-13.33; p = 0.02); this variable was also significant in a multivariate analysis (adjusted odds ratio, 3.8; 95% CI, 1.16-12.6; p = 0.03). Of the co-morbid headache types, only tension headaches were significant (odds ratio, 0.176; 95% CI, 0.04-0.73; p = 0.013). No adverse effects of riboflavin were identified. CONCLUSIONS Low-dose riboflavin is safe and modestly effective for migraines in children. It may be especially beneficial for children without other co-morbid headache types.
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Affiliation(s)
- Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan.
| | - Shinji Suzuki
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Mika Takeshita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Soken Go
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Natsumi Morishita
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Tomoko Takamatsu
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Atsuro Daida
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shinichiro Morichi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yu Ishida
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shingo Oana
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shonosuke Nara
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Masaru Shimura
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shigeo Nishimata
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Kawashima
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan
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19
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Hershey AD, Oskoui M, Pringsheim T, Holler-Managan Y, Potrebic S, Billinghurst L, Gloss D, Licking N, Sowell M, Victorio MC, Gersz E, Vrijsen E, Zanitsch H, Yonker M, Mack K, Gelfand AA, Szperka CL, Powers SW. New Guidelines: Interpretation, Application and the Future. Headache 2020; 59:1133-1143. [PMID: 31529478 DOI: 10.1111/head.13629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2019] [Indexed: 11/27/2022]
Affiliation(s)
- 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
| | - Maryam Oskoui
- Department of Pediatric and Neurology, McGill University, Montréal, Canada.,Department of Neurosurgery, McGill University, Montréal, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yolanda Holler-Managan
- Department of Pediatrics (Neurology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sonja Potrebic
- Neurology Department, Southern California Permanente Medical Group, Kaiser, Los Angeles, CA, USA
| | - Lori Billinghurst
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, WV, USA
| | - Nicole Licking
- Department of Neuroscience and Spine, St. Anthony Hospital-Centura Health, Lakewood, CO, USA
| | - Michael Sowell
- University of Louisville Comprehensive Headache Program and University of Louisville Child Neurology Residency Program, Louisville, KY, USA
| | - M Cristina Victorio
- Division of Neurology, NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, OH, USA
| | | | | | | | - Marcy Yonker
- Division Neurology, Children's Hospital Colorado, Aurora, CO, USA
| | - Kenneth Mack
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Amy A Gelfand
- Department of Neurology, University of San Francisco, San Francisco, CA, USA
| | - Christina L Szperka
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott W Powers
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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20
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Irwin SL, Kacperski J, Rastogi RG. Pediatric Post‐Traumatic Headache and Implications for Return to Sport: A Narrative Review. Headache 2020; 60:1076-1092. [DOI: 10.1111/head.13824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Samantha L. Irwin
- Department of Neurology University of California San Francisco San Francisco CA USA
| | - Joanne Kacperski
- Division of Neurology Cincinnati Children's Hospital Medical Center Cincinnati OH USA
- Department of Pediatrics College of Medicine University of Cincinnati Cincinnati OH USA
| | - Reena G. Rastogi
- Department of Neurology Barrow Neurological Institute at Phoenix Children's Hospital Phoenix AZ USA
- Department of Neurology University of Arizona College of Medicine Phoenix AZ USA
- Department of Child Health University of Arizona College of Medicine Phoenix AZ USA
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21
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Cayir A, Cobanoglu H, Coskun M. Assessment of the genotoxic potential of a migraine-specific drug by comet and cytokinesis-block micronucleus assays. Expert Opin Drug Metab Toxicol 2020; 16:441-446. [PMID: 32275455 DOI: 10.1080/17425255.2020.1748598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Eletriptan is a migraine-specific drug-containing the triptan group. In terms of drug safety, the present study aimed to investigate the genotoxic potential of eletriptan.Research design & methods: We conducted our study by using the cytokinesis-block micronucleus cytome (CBMN) assay, a comprehensive method for measuring micronucleus formation, and a sensitive method for detecting DNA-strand breaks. In the assay, cytokinesis-block proliferation index and the frequency of micronuclei were evaluated in lymphocytes treated with three different concentrations (1, 10 and 25 µg/ml) of eletriptan for 48 hours. In comet assays, DNA damage was evaluated in leucocytes treated with three different concentrations (1, 10 and 25 µg/ml) of eletriptan for an hour.Results: Eletriptan did not induce cytotoxicity nor any increased micronuclei frequencies. While the comet parameters % DNA in tail, tail moment, and the olive moment was found to be significantly increased at 10 and 25 µg/ml, the cytokinesis-block proliferation index values were not.Conclusion: These findings suggest that eletriptan is non-cytotoxic but potentially weakly genotoxic at higher concentrations (10 and 25 µg/ml).
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Affiliation(s)
- Akin Cayir
- Health Services Vocational College, Çanakkale Onsekiz Mart University, Canakkale, Turkey
| | - Hayal Cobanoglu
- Health Services Vocational College, Çanakkale Onsekiz Mart University, Canakkale, Turkey
| | - Munevver Coskun
- Health Services Vocational College, Çanakkale Onsekiz Mart University, Canakkale, Turkey
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22
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Turner AL, Shandley S, Miller E, Perry MS, Ryals B. Intranasal Ketamine for Abortive Migraine Therapy in Pediatric Patients: A Single-Center Review. Pediatr Neurol 2020; 104:46-53. [PMID: 31902550 DOI: 10.1016/j.pediatrneurol.2019.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/16/2019] [Accepted: 10/27/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ketamine has recently emerged as a promising therapeutic alternative for abortive migraine therapy, likely secondary to N-methyl-d-aspartate antagonism. Most reports examine adults and the intravenous route. Fewer utilize intranasal administration or pediatric populations. Given the limited evidence for intranasal ketamine in pediatric migraine populations, we retrospectively reviewed our experience to further characterize safety and efficacy of intranasal ketamine in this population. METHODS A retrospective review in a free-standing, pediatric medical center was performed examining the utilization of intranasal ketamine at 0.1 to 0.2 mg/kg/dose up to five doses in pediatric migraineurs. Pain scores (scale = 0 to 10) were recorded at baseline and after each dose. Response was characterized as pain score reduction to 0 to -3 and/or reduction of at least 50%. RESULTS Twenty-five encounters (25 of 34; 73.5%) were responders (mean pain score reduction of -7.2 from admission to treatment completion). Overall pain reduction from admission to discharge in the entire study population was 66.1%. Side effects were mild and transient. CONCLUSIONS Our experience with intranasal ketamine has promising outcomes in both pain relief and side effect minimization. When other therapeutic options are unavailable, practitioners should consider intranasal ketamine.
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Affiliation(s)
- Adrian L Turner
- Department of Pharmacy, Cook Children's Medical Center, Fort Worth, Texas; Jane and John Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas.
| | - Sabrina Shandley
- Jane and John Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas; Research Administration Office, Cook Children's Medical Center, Fort Worth, Texas
| | - Ean Miller
- Department of Pharmacy, Cook Children's Medical Center, Fort Worth, Texas
| | - M Scott Perry
- Jane and John Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas
| | - Brian Ryals
- Jane and John Justin Neurosciences Center, Cook Children's Medical Center, Fort Worth, Texas
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Walter SM, Banvard-Fox C, Cundiff C. Evaluation and Treatment of Primary Headaches in Adolescents. Prim Care 2020; 47:241-256. [PMID: 32423712 DOI: 10.1016/j.pop.2020.02.004] [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: 12/19/2022]
Abstract
Headache is a common episodic and chronic pain syndrome in adolescents. Evaluation of headaches in primary care requires a comprehensive assessment including lifestyle behaviors and physical examination, as well as an understanding of when to pursue appropriate testing. Primary headache disorders seen in adolescents include migraine and tension-type headache. Pharmacologic management for primary headache includes both acute and prophylactic treatment strategies.
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Affiliation(s)
- Suzy Mascaro Walter
- West Virginia University School of Nursing, 64 Medical Center Drive, Morgantown, WV 26505, USA.
| | - Christine Banvard-Fox
- Department of Pediatrics, Division of Adolescent Medicine, WVU Medicine, West Virginia University, 6040 University Town Center Drive, Morgantown, WV 26501, USA
| | - Courtney Cundiff
- Department of Emergency Medicine, WVU Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26505, USA
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24
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Hornik CP, Gelfand AA, Szperka CL, Pezzuto T, Utevsky A, Kessel S, McCune S, Alexander JJ, Benjamin DK, Cohen-Wolkowiez M. Development of a Prospective Real-World Data Clinical Registry of Children and Adolescents With Migraine. Headache 2020; 60:405-415. [PMID: 31758549 PMCID: PMC7194169 DOI: 10.1111/head.13714] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a multicenter, multistakeholder, prospective clinical registry of children and adolescents with migraine to support the collection of real-world data of sufficient quality to support regulatory submissions and provide site-based infrastructure support for future clinical trials. BACKGROUND As new migraine treatments come to market, pediatric efficacy and safety trials of these agents are needed. A clinical registry is an ideal regulatory strategy to provide both real-world data and site infrastructure to execute these trials. DESIGN Multicenter, multistakeholder, prospective real-world data clinical registry of children and adolescents, 4-17 years of age, diagnosed with migraine with or without aura. Participants will be followed for up to 12 months at 3-month intervals, with interval recording of clinical data at study sites and self-reported data via mobile health application, as well as biobanking. We developed electronic case report forms that incorporated routinely collected clinical data with National Institute of Neurological Disorders and Stroke Headache Common Data Elements (Version 2.0). All data are captured in a 21 CFR Part 11 - compliant electronic data capture system - augmented by a real-time, web-based, and customizable data visualization platform. We engaged vendors to provide ancillary biobanking, patient data entry, and data visualization services. RESULTS We used an iterative and highly collaborative multistakeholder approach to design and implement a streamlined registry protocol with input from all participating US sites. At each design and implementation step, we received input from therapeutic area experts, the US Food and Drug Administration (FDA), the National Institutes of Health, patient and parent advocates, health technology partners, drug developers, and site-based clinical investigators. The registry is governed by a multistakeholder steering committee with representation from sites, industry partners, patient advocates, and a member from the FDA (non-voting with respect to steering committee matters). The multistakeholder and site-driven approach to registry design and execution was highly efficient and resulted in the first patient enrolled within 6 months of concept development. CONCLUSIONS By ensuring regulatory compliant implementation of the registry, we created both a source of real-world data and a multisite platform for the conduct of future clinical trials that can be submitted to regulatory authorities to support inclusion of pediatric data in approved drug labeling. A highly collaborative approach with broad stakeholder engagement at all stages of the registry development was a key to our operational success.
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Affiliation(s)
- Christoph P. Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Amy A. Gelfand
- University of California San Francisco, Child & Adolescent Headache Program, San Francisco, CA
| | - Christina L. Szperka
- Children’s Hospital of Philadelphia, Pediatric Headache Program, & Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Tara Pezzuto
- Nemours/Alfred I. DuPont Hospital for Children, Nemours Neurology Headache Program, Wilmington, DE
| | - Amanda Utevsky
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Susan McCune
- Office of Pediatric Therapeutics, US Food and Drug Administration, Silver Spring, MD
| | - John J. Alexander
- Division of Pediatric and Maternal Health, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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25
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Zafarmand S, Javanmardi H, Ameri M, Maneshi M, Mansouri-Mehrabadi S, Zolghadrasli Y, Moazzam M, Aramesh A, Borhani-Haghighi A. Evaluation of the Neurological Complaints during Pregnancy and Postpartum. Galen Med J 2019; 8:e1616. [PMID: 34466537 PMCID: PMC8343816 DOI: 10.31661/gmj.v8i0.1616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/19/2019] [Accepted: 10/17/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pregnancy and postpartum are critical periods for patients with neurological complications. In this study, we aimed to evaluate the clinical characteristics and outcome of pregnant women with neurological conditions. MATERIALS AND METHODS This cross-sectional study reviewed pregnant women with neurological signs and symptoms, who were registered in the Medical Care Monitoring Center (MCMC) database of Shiraz University of Medical Sciences 2013-15. A questionnaire was designed to record each patient's information including demographic variables, past medical history, clinical presentation, obstetric profile, and fetal/maternal outcomes. RESULTS Totally, 332 mothers were registered in the database. The main neurological complaints in our population were headache, seizure, unilateral neurological symptoms, multiple sclerosis, neuromuscular disorder, and brain tumor. More than half of the patients (54%) experienced headache during the pregnancy and postpartum period. CONCLUSION Evaluating the neurological disorders separately, based on the time of symptom onset indicates the importance of follow-up of mothers during peripartum. Our findings suggest that decisions for pregnancy in women with neurological disorders should be based on risks outweighing for the mother and the fetus, particularly regarding the pharmacological side effects.
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Affiliation(s)
- Shaghayegh Zafarmand
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haniyeh Javanmardi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ameri
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Maneshi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Yasaman Zolghadrasli
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshad Moazzam
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ayda Aramesh
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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26
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Abstract
This article outlines key features of diagnosis and treatment of migraine in children and adolescents. It emphasizes techniques that can be used by clinicians to optimize history taking in this population, as well as recognition of episodic conditions that may be associated with migraine and present in childhood. Acute treatment strategies include use of over-the-counter analgesics and triptan medications that have been approved by the US Food and Drug Administration for use in children and adolescents. Preventive treatment approach includes lifestyle modifications, behavioral strategies, and consideration of preventive medications with the lowest side effect profiles.
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Affiliation(s)
- Kaitlin Greene
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA
| | - Samantha L Irwin
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA
| | - Amy A Gelfand
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA.
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27
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Gutta R, Valentini KJ, Kaur G, Farooqi AA, Sivaswamy L. Management of Childhood Migraine by Headache Specialist vs Non‐Headache Specialists. Headache 2019; 59:1537-1546. [DOI: 10.1111/head.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Radhika Gutta
- Michigan State University School of Medicine Lansing MI USA
| | | | | | - Ahmad A. Farooqi
- Department of Pediatrics Wayne State University School of Medicine Detroit MI USA
| | - Lalitha Sivaswamy
- Department of Pediatrics at Children's Hospital of Michigan Wayne State University School of Medicine Detroit MI USA
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28
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Stubberud A, Flaaen NM, McCrory DC, Pedersen SA, Linde M. Flunarizine as prophylaxis for episodic migraine: a systematic review with meta-analysis. Pain 2019; 160:762-772. [PMID: 30699098 DOI: 10.1097/j.pain.0000000000001456] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Based on few clinical trials, flunarizine is considered a first-line prophylactic treatment for migraine in several guidelines. In this meta-analysis, we examined the pooled evidence for its effectiveness, tolerability, and safety. Prospective randomized controlled trials of flunarizine as a prophylaxis against migraine were identified from a systematic literature search, and risk of bias was assessed for all included studies. Reduction in mean attack frequency was estimated by calculating the mean difference (MD), and a series of secondary outcomes-including adverse events (AEs)-were also analyzed. The database search yielded 879 unique records. Twenty-five studies were included in data synthesis. We scored 31/175 risk of bias items as "high," with attrition as the most frequent bias. A pooled analysis estimated that flunarizine reduces the headache frequency by 0.4 attacks per 4 weeks compared with placebo (5 trials, 249 participants: MD -0.44; 95% confidence interval -0.61 to -0.26). Analysis also revealed that the effectiveness of flunarizine prophylaxis is comparable with that of propranolol (7 trials, 1151 participants, MD -0.08; 95% confidence interval -0.34 to 0.18). Flunarizine also seems to be effective in children. The most frequent AEs were sedation and weight increase. Meta-analyses were robust and homogenous, although several of the included trials potentially suffered from high risk of bias. Unfortunately, reporting of AEs was inconsistent and limited. In conclusion, pooled analysis of data from partially outdated trials shows that 10-mg flunarizine per day is effective and well tolerated in treating episodic migraine-supporting current guideline recommendations.
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Affiliation(s)
- Anker Stubberud
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Nikolai Melseth Flaaen
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Douglas C McCrory
- Duke Evidence Synthesis Group, Duke Clinical Research Institute, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States.,Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - Sindre Andre Pedersen
- Library Section for Medicine and Health Sciences, NTNU University Library, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Mattias Linde
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Advisory Unit on Headaches, St. Olavs Hospital, Trondheim, Norway
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29
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Kovalchuk PV, Katilov OV, Panenko SO. Modern approaches to diagnostics and treatment of migraine in children. PAIN MEDICINE 2019. [DOI: 10.31636/pmjua.v3i4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article reviews modern approaches to diagnostics and treatment of a very common and simultaneously underestimated and often maltreated disorder in children. It is fallacious management of migraine masked behind the diagnoses such as autonomic vessel dysfunction and vascular headache here in Ukraine. This is a tremendous problem and it should be solved with appropriate information spread across the medical community.
Up-to-date classification according to the International Headache Society, diagnostic criteria, differential diagnosis, investigation and treatment strategies are presented in the article. All supported data are com-pliant with guidelines of developed countries with evidence-based medicine (US, Canada, Great Britain, Japan, Australia, New Zealand) enhanced with new trials and approved methods. Migraine management is a rapidly evolving concept, where major changes were done during recent years (transcranial Deep Brain Stimulation, vagus stimulation, CGRP-receptor mono-clonal antibodies).
Considering disorder incidence and its impact on life quality and the existence of options for alleviating symptoms, this information is important for physicians who work with children, especially for general practitioners, pediatrics, pediatric and adult neurologists.
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30
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Diener HC, Holle-Lee D, Nägel S, Dresler T, Gaul C, Göbel H, Heinze-Kuhn K, Jürgens T, Kropp P, Meyer B, May A, Schulte L, Solbach K, Straube A, Kamm K, Förderreuther S, Gantenbein A, Petersen J, Sandor P, Lampl C. Treatment of migraine attacks and prevention of migraine: Guidelines by the German Migraine and Headache Society and the German Society of Neurology. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2019. [DOI: 10.1177/2514183x18823377] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In collaboration with some of the leading headache centres in Germany, Switzerland and Austria, we have established new guidelines for the treatment of migraine attacks and the prevention of migraine. A thorough literature research of the last 10 years has been the basis of the current recommendations. At the beginning, we present therapeutic novelties, followed by a summary of all recommendations. After an introduction, we cover topics like drug therapy and practical experience, non-effective medication, migraine prevention, interventional methods, non-medicational and psychological methods for prevention and therapies without proof of efficacy.
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Affiliation(s)
- Hans-Christoph Diener
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Essen, Germany
| | - Dagny Holle-Lee
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Essen, Germany
| | - Steffen Nägel
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum, Universitätsklinikum Essen, Essen, Germany
| | - Thomas Dresler
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Tübingen, Germany
- Graduiertenschule & Forschungsnetzwerk LEAD, Universität Tübingen, Tübingen, Germany
| | - Charly Gaul
- Migräne- und Kopfschmerzklinik Königstein, Königstein im Taunus, Germany
| | | | | | - Tim Jürgens
- Universitätsmedizin Rostock, Zentrum für Nervenheilkunde, Klinik und Poliklinik für Neurologie, Rostock, Germany
| | - Peter Kropp
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Zentrum für Nervenheilkunde, Rostock, Germany
| | - Bianca Meyer
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Zentrum für Nervenheilkunde, Rostock, Germany
| | - Arne May
- Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany
| | - Laura Schulte
- Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg, Germany
| | - Kasja Solbach
- Klinik für Neurologie, Universitätsklinikum Essen, Essen, Germany
| | - Andreas Straube
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Germany
| | - Katharina Kamm
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Germany
| | - Stephanie Förderreuther
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, München, Germany
| | | | - Jens Petersen
- Klinik für Neurologie, Universitätsspital Zürich, Zürich, Swizterland
| | - Peter Sandor
- RehaClinic Bad Zurzach, Bad Zurzach, Swizterland
| | - Christian Lampl
- Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern Linz Betriebsgesellschaft m.b.H., Linz, Austria
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Kroon Van Diest AM, Powers SW. Cognitive Behavioral Therapy for Pediatric Headache and Migraine: Why to Prescribe and What New Research Is Critical for Advancing Integrated Biobehavioral Care. Headache 2018; 59:289-297. [PMID: 30444269 DOI: 10.1111/head.13438] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To highlight current evidence supporting the prescription of cognitive behavioral therapy (CBT) as part of first-line preventive treatment for children and adolescents with headache and discuss a research strategy aimed at: (1) understanding how and why CBT works, and (2) developing effective and efficient approaches for integrating CBT into headache specialty, neurology, and primary care settings. RECENT FINDINGS Although preventive medications for pediatric headache and migraine are commonly prescribed, recent meta-analyses and an NIH-funded, multi-center clinical trial suggests that the effect of pill-taking therapies may be mostly due to a placebo effect. These findings have led to greater consideration of prescription of non-pharmacological therapies as first-line interventions (either alone or in combination with pill-based therapy). A literature that extends back to the 1980s and includes recent clinical trials and meta-analyses demonstrates that CBT decreases headache frequency and related disability in youth with headache and migraine and has a favorable benefit to risk profile with almost no negative side effects. SUMMARY CBT has been repeatedly demonstrated as effective in treating pediatric headache and migraine. As such, it should be considered as part of first-line preventive treatment for pediatric headache (either alone or in combination with a pill-based therapy). We need to better understand how this therapy works and what makes it distinct (if anything) from the placebo effect. What we need to achieve is empirical support for efficient access to this evidence-based treatment and clarity on how to match the intensity of non-pharmacological intervention to the needs of our patients at the time they present for care.
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Affiliation(s)
- Ashley M Kroon Van Diest
- Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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32
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Rastogi RG, Borrero-Mejias C, Hickman C, Lewis KS, Little R. Management of Episodic Migraine in Children and Adolescents: a Practical Approach. Curr Neurol Neurosci Rep 2018; 18:103. [DOI: 10.1007/s11910-018-0900-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Safety and Efficacy of IV Lidocaine in the Treatment of Children and Adolescents With Status Migraine. Pediatr Crit Care Med 2018; 19:755-759. [PMID: 29923942 DOI: 10.1097/pcc.0000000000001629] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of IV lidocaine in treating children and adolescents with status migraine. DESIGN Retrospective observational study. SETTING Single center PICU. PATIENTS Children and adolescents admitted with status migraine. INTERVENTION IV lidocaine. MEASUREMENT AND MAIN RESULTS Thirty-three lidocaine infusions were administered to 28 patients with status migraine. Two patients were excluded from analysis, leaving 31 infusions administered to 26 patients for analysis. Patients' ages ranged from 10 to 19 years with an average of 14.9 ± 2.4 years. Mean duration of hospitalization was 4.6 ± 1.5 days. Lidocaine was administered as a bolus (2.9 ± 0.18 mg/kg) in 80.6% (95% CI, 63.7-90.8%) of the patients, followed by an infusion, which was started at a mean rate of 1.29 ± 0.2 mg/kg/hr with mean maximum dose of 1.56 ± 0.27 mg/kg/hr. The highest lidocaine drip was 2.25 mg/kg/hr and lowest 1.125 mg/kg/hr. Lidocaine was interrupted in one patient secondary to side effects: chest pain and anxiety. On average, it took 16.3 ± 12.9 hours for 50% reduction in pain scores (range, 1.3-40.4 hr) and 19.3 ± 19.3 hours for complete resolution (0.8-72.1). 90.3% of cases (95% CI, 75.1-96.6%) experienced pain resolution with 51.6% (95% CI, 34.8-68%) encountering a relapse of pain. Mean pain scores at the time of discharge were 1 ± 1.6 (median, 0). Both mean reported highest and lowest scores dropped over the course of the 5 days from 5.1 ± 1.9 and 2.1 ± 2.4 on day 1 to 1.0 ± 1.4 and 0 on day 5 of therapy. One-way analysis by analysis of variance for high pain score by day was statistically significant with a p value of less than 0.01. CONCLUSIONS In the appropriate patient population, IV lidocaine may be a safe and effective treatment for children and adolescents with status migraine. Larger prospective studies need to be done not only to evaluate safety and efficacy but also the analgesic longevity of IV lidocaine post discharge.
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Devaraja K. Vertigo in children; a narrative review of the various causes and their management. Int J Pediatr Otorhinolaryngol 2018; 111:32-38. [PMID: 29958611 DOI: 10.1016/j.ijporl.2018.05.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/03/2023]
Abstract
Vertigo is a not an uncommon symptom in children, but often the treating doctors are unsure of the diagnosis and the management of these cases. This narrative review of the literature discusses the brief etiopathology, the clinical manifestations and the management algorithm of most of the conditions causing vertigo in children. The relevant information has been condensed into a table for the perusal of the readers, which would assist in the appropriate management of these children.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Udupi, Karnataka, 576104, India.
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35
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Abstract
BACKGROUND Few studies have reported prescription patterns for headache medication. OBJECTIVE The aim was to present the rates of specific medication prescribed to pediatric patients diagnosed with migraine, tension-type headache (TTH), and new daily persistent headache (NDPH), as well as differences in those prescription patterns by diagnosis, age, and gender. PATIENTS AND METHODS A query using the i2b2 platform yielded 14,591 patients [migraine 10,547 (72.3%); TTH 3200 (21.9%); NDPH 844 (5.8%)] seen over a 3-year period, who were aged 4-17 years at the time of their visit and diagnosed with migraine, TTH, or NDPH. RESULTS Sumatriptan was the most frequently prescribed medication for migraine followed by amitriptyline. The most frequently prescribed medication for both TTH and NDPH was amitriptyline, followed by sumatriptan in TTH and by topiramate in NDPH. Age and gender differences were also found in prescription patterns of each of the diagnoses. The differences in prescription patterns found between the diagnoses, as well as age and gender differences found within the diagnoses, are discussed. CONCLUSIONS A wide range of medications are prescribed to children and adolescents with headache, with most medications prescribed for off-label use. As these medications are not Food and Drug Administration (FDA) approved for use in children and adolescents with headache, there is a need for large scale, randomized controlled trials to assess the efficacy of these medications.
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Raggi A, Grignani E, Leonardi M, Andrasik F, Sansone E, Grazzi L, D'Amico D. Behavioral Approaches for Primary Headaches: Recent Advances. Headache 2018; 58:913-925. [DOI: 10.1111/head.13337] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/27/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Eleonora Grignani
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Frank Andrasik
- Department of Psychology; University of Memphis; Memphis TN USA
| | - Emanuela Sansone
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Licia Grazzi
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
| | - Domenico D'Amico
- Division of Neuroalgology; Neurological Institute C. Besta IRCCS Foundation; Milan Italy
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Abstract
Migraine is a chronic paroxysmal neurological disorder characterised by multiphase attacks of head pain and a myriad of neurological symptoms. The underlying genetic and biological underpinnings and neural networks involved are coming sharply into focus. This progress in the fundamental understanding of migraine has led to novel, mechanism-based and disease-specific therapeutics. In this Seminar, the clinical features and neurobiology of migraine are reviewed, evidence to support available treatment options is provided, and emerging drug, device, and biological therapies are discussed.
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Talebian A, Soltani B, Banafshe HR, Moosavi GA, Talebian M, Soltani S. Prophylactic effect of riboflavin on pediatric migraine: a randomized, double-blind, placebo-controlled trial. Electron Physician 2018; 10:6279-6285. [PMID: 29629048 PMCID: PMC5878019 DOI: 10.19082/6279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 09/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background and aim Riboflavin may have an acceptable effect on migraine among children. This study was carried out to determine the prophylactic effect of riboflavin on migraine in children. Methods This randomized clinical trial study was performed at Shahid Beheshti Hospital in Kashan, Iran from December 2012 to February 2015. Ninety children with migraine were allocated randomly into 3 groups (placebo, low-dose and high-dose riboflavin). The outcomes (frequency, intensity and duration of headaches) were measured at baseline and 12 weeks of medication in each group, and the decrease of them were compared. SPSS software version 16 was used for analysis of the data. Descriptive statistics, Chi-square, Fisher's exact and t-test were used for statistical analyses. Results There was a significant decrease of migraine frequency (p=0.000) and mean duration (p=0.000) in the high-dose group compared with the placebo group. No significant reduction of frequency and mean duration of attacks were reported in the low-dose group compared to the placebo group (p=0.49 and p=0.69 respectively). There was no significant reduction of migraine intensity in the low-dose and high-dose groups compared to the placebo group (p=0.71 and p=0.74 respectively). Conclusion High-dose riboflavin is a safe, well tolerated, cost-effective method of prophylaxis for children with migraine. Trial registration The trial was registered at the Iranian Clinical Trial Registry with number IRCT2013020412361N1. Funding The study was supported by the Deputy of Research, Kashan University of Medical Sciences (grant number 91073).
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Affiliation(s)
- Ahmad Talebian
- M.D., Pediatric Neurologist, Professor, Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran.,Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Babak Soltani
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran.,M.D., Pediatric Infectious Diseases specialist, Associate Professor, Department of Pediatrics, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Banafshe
- Ph.D. of Pharmacology, Associate Professor, Department of Pharmacology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Gholam Abbas Moosavi
- M.Sc. of biostatistics, Lecturer, Department of Public Health, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Motahhareh Talebian
- M.D., Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Soltani
- M.D., Forensic Medicine Specialist, Assistant Professor, Department of Forensic Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Little RD. Emergency Department Evaluation and Management of Children With Headaches. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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41
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Faber AJ, Lagman-Bartolome AM, Rajapakse T. Drugs for the acute treatment of migraine in children and adolescents. Paediatr Child Health 2017; 22:454-458. [PMID: 29479263 DOI: 10.1093/pch/pxx170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
| | | | - Thilinie Rajapakse
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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42
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Abstract
Headache and seizures are two of the most common complaints seen in the field of pediatric neurology with headache being number one. Both these conditions may coexist. Where the difficulty begins is when the symptoms are not clear cut in making a diagnosis, and conditions are possible as either an atypical seizure or migraine variant. What further complicates matters is the fact that there are many underlying neurologic conditions that carry with them a higher likelihood of developing both headaches and seizures, making each a distinct possibility when obtaining a history from a parent about unusual spells. Although differentiating between seizure and headache may not be easy, with a focused yet thorough history and appropriate use of investigative tools, it can be done. Coming to the correct diagnosis is only the start; once seizures and or headaches have been appropriately diagnosed then the real challenge begins and that is finding a way to successfully treat the headaches and seizures. Within pediatric neurology, the acute options tend to be more diagnosis specific whereas the prophylactic ones may overlap and treat both headaches and seizures. In the following review, we will discuss the epidemiology of pediatric headaches and seizures, the overlap between these 2 conditions in diagnosis, as well as how to tell them apart, and the treatment options and prognosis of both common neurologic disorders in children.
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Affiliation(s)
- Christopher B Oakley
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Eric H Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
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43
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Jeric M, Surjan N, Jelicic Kadic A, Riva N, Puljak L. Treatment of acute migraine attacks in children with analgesics on the World Health Organization Essential Medicines List: A systematic review and GRADE evidence synthesis. Cephalalgia 2017; 38:1592-1607. [PMID: 29034788 DOI: 10.1177/0333102417736902] [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] [Indexed: 01/08/2023]
Abstract
Background The World Health Organization Essential Medicines List (WHO EML) contains two analgesics for treatment of acute migraine attacks in children, ibuprofen and paracetamol. Methods The Embase, CDSR, CENTRAL, DARE and MEDLINE databases were searched up to 18 April 2017. We analyzed randomized controlled trials (RCTs) and systematic reviews (SRs) that investigate the efficacy and safety of ibuprofen or paracetamol for treatment of acute migraine attacks in children. We conducted meta-analysis and assessments of evidence with GRADE, Cochrane risk of bias tool, and AMSTAR. Results Three RCTs (201 children) and 10 SRs on ibuprofen and/or paracetamol for acute migraine attacks in children were included. Meta-analysis indicated that ibuprofen was superior to placebo for pain-free at 2 h or pain relief at 2 h, without difference in adverse events. There were no differences between paracetamol and placebo, or ibuprofen and paracetamol. Ten SRs that analyzed various therapies for migraine in children were published between 2004 and 2016, with discordant conclusions. Conclusion Limited data from poor quality RCTs indicate that ibuprofen and paracetamol might be effective analgesics for treating migraine attacks in children. Inclusion of ibuprofen and paracetamol as antimigraine medicines for children in the WHO EML is supported by indirect evidence from studies in adults.
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Affiliation(s)
- Milka Jeric
- 1 Department of Dermatovenerology, General Hospital Zadar, Zadar, Croatia
| | - Nives Surjan
- 2 Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia
| | - Antonia Jelicic Kadic
- 2 Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia.,3 Department of Pediatrics, University Hospital Split, Split, Croatia
| | - Nicoletta Riva
- 4 Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Livia Puljak
- 2 Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia.,5 Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
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Abstract
OBJECTIVE Migraine treatment varies widely in the pediatric emergency department (ED). Factors associated with discharge after only initial emergency treatment were examined. METHODS A retrospective chart analysis was conducted on patients 6 to 18 years old who presented to the St. Louis Children's Hospital ED between January 1, 2008, and December 31, 2011, with a discharge diagnosis of migraine (n = 700 visits). Associations between patient characteristics, initial treatments, and rates of discharge after only initial treatment were examined using a generalized linear model and receiver operating characteristic curves. RESULTS If exclusively oral or intranasal (PO/IN) medications were given initially (n = 285), ibuprofen alone was associated with lower discharge rates compared with other PO/IN medication regimens (P < 0.05). The only other variable associated with discharge was arrival pain score (P < 0.05). When ibuprofen alone was administered, pain scores equal to or lower than 5/10 were associated with the greatest sensitivity and specificity for discharge. With administration of other PO/IN regimens, pain scores equal to or lower than 8/10 were associated with the greatest sensitivity and specificity for discharge. If intravenous (IV) medications were given initially (n = 415), ketorolac given with an antinausea medication was associated with higher discharge rates compared with independent administration of these medications (P < 0.05). Intravenous medications were associated with higher discharge rates compared with PO/IN medications (P < 0.001). CONCLUSIONS Arrival pain score may be used to help select initial migraine treatment in the pediatric ED. Initial use of PO/IN regimens including triptans or an antiemetic and concurrent administration of IV ketorolac with an antiemetic may be associated with higher rates of discharge after initial treatment alone.
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New Developments in the Prophylactic Drug Treatment of Pediatric Migraine: What Is New in 2017 and Where Does It Leave Us? Curr Pain Headache Rep 2017; 21:38. [DOI: 10.1007/s11916-017-0638-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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47
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Le K, Yu D, Wang J, Ali AI, Guo Y. Is topiramate effective for migraine prevention in patients less than 18 years of age? A meta-analysis of randomized controlled trials. J Headache Pain 2017; 18:69. [PMID: 28721545 PMCID: PMC5515721 DOI: 10.1186/s10194-017-0776-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/29/2017] [Indexed: 11/10/2022] Open
Abstract
Background Mainly based on evidence of success in adults, various medications are commonly used to prevent pediatric migraines. Topiramate has been approved for migraine prevention in children as young as 12 years of age. In this meta-analysis, we aimed to assess the currently published data pertaining to the efficacy of topiramate for migraine prevention in patients less than 18 years of age. Methods We searched PubMed/Medline, Embase and the Cochrane Library (from inception to April 2017) for randomized controlled trials (RCTs) published in English. Two independent investigators performed data extraction and quality evaluation using the Cochrane Collaboration’s tool. The data extracted were analyzed by Review Manager 5.3 software. Results A total of four RCTs matching the inclusion criteria were included, with an aggregate of 465 patients. Of these patients, 329 were included in the topiramate group, and 136 were included in the placebo group. This meta-analysis revealed that compared with placebo, topiramate failed to decrease the number of patients experiencing a ≥ 50% relative reduction in headache frequency (n = 465, RR = 1.26, 95% CI = [0.94,1.67], Z = 1.55, P = 0.12) or the number of headache days (n = 465, MD = −0.77, 95% CI = [−2.31,0.76], Z = 0.99, P = 0.32) but did reduce PedMIDAS scores (n = 205, MD = −9.02, 95% CI = [−17.34, −0.70], Z = 2.13, P = 0.03). Higher rates of side effects and adverse events in the topiramate group than in the placebo group were observed in the included trials. Conclusions Topiramate may not achieve a more effective clinical trial endpoint than placebo in the prevention of migraines in patients less than 18 years of age, and topiramate may lead to more side effects or adverse events in the included patients.
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Affiliation(s)
- Kai Le
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Dafan Yu
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Jiamin Wang
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Abdoulaye Idriss Ali
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China
| | - Yijing Guo
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, 210009, People's Republic of China.
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Lai LL, Koh L, Ho JAC, Ting A, Obi A. Off-Label Prescribing for Children with Migraines in U.S. Ambulatory Care Settings. J Manag Care Spec Pharm 2017; 23:382-387. [PMID: 28230456 PMCID: PMC10397622 DOI: 10.18553/jmcp.2017.23.3.382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Migraines, Which Affect About 10% Of School-Age Children In The United States, Can Significantly Impair Quality Of Life. Despite Potential Disability, Many Children Do Not Receive Treatment Or Prophylaxis, Since Medications Specifically Approved For Children Are Significantly Less Than For Adults. There Is Also Controversy Surrounding The Apparent Widespread Practice Of Prescribing Off-Label Medications For Children With Migraines. However, Little Research Has Been Done To Identify Physician-Prescribing Patterns Of Migraine Medication For Children. OBJECTIVE To Investigate The Prevalence And Pattern Of Off-Label Prescribing For Children With Migraines. METHODS A Secondary Data Analysis Was Conducted Using The Pooled National Ambulatory Medical Care Survey (Namcs) 2011 And 2012. Patients Aged 17 Years Or Younger With A Migraine Diagnosis Were Included. A Series Of Weighted Descriptive Analyses Were Used To Estimate The Prevalence Of Migraine Drugs Prescribed During Pediatric Office Visits. A Weighted Logistic Regression Was Constructed To Compare The Prescribing Patterns Between Off-Label And Fda-Approved Medications. Analyses Used Sas 9.4 Methodology And Incorporated Sample Weights To Adjust For The Complex Sampling Design Employed By Namcs. RESULTS Of The 12.9 Million Outpatient Visits With A Migraine Diagnosis That Took Place Between 2010 And 2012, 1.2 Million Were Pediatric Visits. Females Accounted For Nearly Twice The Number Of Migraine Visits Than Males (66% Vs. 34%). Children Aged 12-17 Years Accounted For The Highest Frequency Of Visits (84%), Compared With Those Aged Under 12 Years (16%). 66.7% Of These Pediatric Patients Received At Least 1 Migraine Drug. Of These, Off-Label Medications Were Prescribed 1.5 Times More Than Fda-Approved Medications For Children (60.34% Vs. 39.65%). The Results Of Logistic Regression Showed A Significant Likelihood Of Prescribing Off-Label Medications Based On Physician Specialty, Patient Race, And Reason For Visit. Neurologists (Or = 0.028, P < 0.05) And Pediatricians (Or = 0.095, P < 0.05) Were Less Likely To Prescribe Off-Label Drugs Than General And Family Practitioners. Visits For Preventive Care (Or = 5.8, P < 0.05) And Flare-Ups From Chronic Migraines (Or = 5.0, P < 0.05) Were More Likely To Result In Off-Label Drug Prescriptions Than Visits For New Migraine Incidence. CONCLUSIONS This Study Provides Significant Real-World Evidence Of The Widespread Practice Of Prescribing Off-Label Drugs To Children With Migraines. Although Medical Literature Shows That Off-Label Prescribing May Not Be Harmful, There Is A Dearth Of Research And Practice Guidelines To Help Practitioners Uphold Safety Standards And Ensure The Prescription Of Age-Appropriate Medications To Children. DISCLOSURES No outside funding supported this study. The authors report no potential conflicts of interest relevant to this research. Lai and Ting contributed to study concept and design and collected the data, along with the other authors. Data interpretation was performed by Lai, Koh, Obi, Ho, and Ting. The manuscript was written and revised by Lai, Koh, and Ho, with assistance from Ting and Obi.
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Affiliation(s)
- L Leanne Lai
- 1 Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida
| | - Leroy Koh
- 1 Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida
| | - Jane Ai-Chen Ho
- 1 Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida
| | - Alexander Ting
- 2 University of Florida College of Liberal Arts, Gainesville
| | - Augustine Obi
- 1 Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida
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Lai KL, Niddam DM, Fuh JL, Chen SP, Wang YF, Chen WT, Wu JC, Wang SJ. Flunarizine versus topiramate for chronic migraine prophylaxis: a randomized trial. Acta Neurol Scand 2017; 135:476-483. [PMID: 27306581 DOI: 10.1111/ane.12626] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Chronic migraine (CM) is a prevalent and devastating disorder with limited therapeutic options. This study explored the efficacy of 10 mg/d flunarizine for CM prophylaxis as compared with 50 mg/d topiramate. METHODS We conducted a prospective, randomized, open-label, blinded-endpoint trial. Patients with CM were randomized to flunarizine and topiramate treatment. The primary outcomes assessed were the reductions in the total numbers of headache days and migraine days after 8 weeks of treatment. Secondary outcomes were reductions in the numbers of days of acute abortive medication intake and acute abortive medication tablets taken, and the 50% responder rate. RESULTS Sixty-two subjects were randomized (n=31/group). Patients treated with flunarizine showed significant reductions in the numbers of total headache days (-4.9 vs -2.3, P=.012) and migraine days (-4.3 vs -1.4, P=.001) compared with those treated with topiramate. Patients treated with flunarizine also showed significant reductions in the numbers of days of acute abortive medication intake (-2.3 vs -0.2, P=.005) and acute abortive medication tablets taken (-4.6 vs -0.5, P=.005) and had a higher 50% responder rate in terms of total headache days (58.6% vs 25.9%, P=.013) and migraine days (75.9% vs 29.6%, P=.001), compared with topiramate-treated patients. Flunarizine was generally well tolerated and had a safety profile comparable to that of topiramate. CONCLUSIONS Our results suggest that, in an 8-week study, 10 mg/d flunarizine is more effective than 50 mg/d topiramate for CM prophylaxis.
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Affiliation(s)
- K.-L. Lai
- Department of Neurology; Taipei Municipal Gandau Hospital; Taipei Taiwan
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Clinical Medicine; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - D. M. Niddam
- Institute of Brain Science; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - J.-L. Fuh
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - S.-P. Chen
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Y.-F. Wang
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - W.-T. Chen
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Brain Science; School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - J.-C. Wu
- Institute of Clinical Medicine; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Division of Gastroenterology; Department of Internal Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - S.-J. Wang
- Department of Neurology; Neurological Institute; Taipei Veterans General Hospital; Taipei Taiwan
- Department of Neurology; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Brain Science; School of Medicine; National Yang-Ming University; Taipei Taiwan
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50
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Abstract
Headaches are common in childhood and adolescence and can cause significant distress and disability for a child and their family. Providers need to be able to identify "red flags" for worrisome causes of secondary headaches and recognize typical primary headache characteristics to provide each patient with the best possible care to improve their quality of life and minimize disability. This article reviews the epidemiology of headaches in children, signs and symptoms of secondary headaches, definitions of some primary childhood headaches, and options for management of both acute and chronic pediatric migraine. [Pediatr Ann. 2017;46(4):e155-e165.].
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