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Gómez-Dabó L, Caronna E, Mas-de-les-Valls R, Gallardo VJ, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. Effectiveness and Safety of OnabotulinumtoxinA in Adolescent Patients with Chronic Migraine. Toxins (Basel) 2024; 16:221. [PMID: 38787073 PMCID: PMC11126010 DOI: 10.3390/toxins16050221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Chronic migraine (CM) significantly affects underage individuals. The study objectives are (1) to analyze the effectiveness and safety of onabotulinumtoxinA (BTX-A) in adolescents with CM; (2) to review the literature on BTX-A use in the pediatric population. This prospective observational study included patients under 18 years old with CM treated with BTX-A (PREEMPT protocol) as compassionate use. Demographic, efficacy (monthly headache days-MHD; monthly migraine days-MMD; acute medication days/month-AMDM) and side effect data were collected. A ≥ 50% reduction in MHD was considered as a response. Effectiveness and safety were analyzed at 6 and 12 months. A systematic review of the use of BTX-A in children/adolescents was conducted in July 2023. In total, 20 patients were included (median age 15 years [14.75-17], 70% (14/20) females). The median basal frequencies were 28.8 [20-28] MHD, 18 [10-28] MMD and 10 [7.5-21.2] AMDM. Compared with baseline, at 6 months (n = 20), 11 patients (55%) were responders, with a median reduction in MHD of -20 days/month (p = 0.001). At 12 months (n = 14), eight patients (57.1%) were responders, with a median reduction in MHD of -17.5 days/month (p = 0.002). No adverse effects were reported. The literature search showed similar results. Our data supports the concept that BTX-A is effective, well tolerated, and safe in adolescents with CM resistant to oral preventatives.
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Affiliation(s)
- Laura Gómez-Dabó
- Headache Clinic, Neurology Department, Vall d’Hebron Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (L.G.-D.); (E.C.); (A.A.); (M.T.-F.)
- Headache and Neurological Pain Research Group, Vall d’Hebron Institut de Recerca (VHIR), Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (R.M.-d.-l.-V.); (V.J.G.)
| | - Edoardo Caronna
- Headache Clinic, Neurology Department, Vall d’Hebron Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (L.G.-D.); (E.C.); (A.A.); (M.T.-F.)
- Headache and Neurological Pain Research Group, Vall d’Hebron Institut de Recerca (VHIR), Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (R.M.-d.-l.-V.); (V.J.G.)
| | - Rut Mas-de-les-Valls
- Headache and Neurological Pain Research Group, Vall d’Hebron Institut de Recerca (VHIR), Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (R.M.-d.-l.-V.); (V.J.G.)
| | - Víctor J. Gallardo
- Headache and Neurological Pain Research Group, Vall d’Hebron Institut de Recerca (VHIR), Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (R.M.-d.-l.-V.); (V.J.G.)
| | - Alicia Alpuente
- Headache Clinic, Neurology Department, Vall d’Hebron Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (L.G.-D.); (E.C.); (A.A.); (M.T.-F.)
- Headache and Neurological Pain Research Group, Vall d’Hebron Institut de Recerca (VHIR), Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (R.M.-d.-l.-V.); (V.J.G.)
| | - Marta Torres-Ferrus
- Headache Clinic, Neurology Department, Vall d’Hebron Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (L.G.-D.); (E.C.); (A.A.); (M.T.-F.)
- Headache and Neurological Pain Research Group, Vall d’Hebron Institut de Recerca (VHIR), Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (R.M.-d.-l.-V.); (V.J.G.)
| | - Patricia Pozo-Rosich
- Headache Clinic, Neurology Department, Vall d’Hebron Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (L.G.-D.); (E.C.); (A.A.); (M.T.-F.)
- Headache and Neurological Pain Research Group, Vall d’Hebron Institut de Recerca (VHIR), Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain; (R.M.-d.-l.-V.); (V.J.G.)
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Onofri A, Pensato U, Rosignoli C, Wells-Gatnik W, Stanyer E, Ornello R, Chen HZ, De Santis F, Torrente A, Mikulenka P, Monte G, Marschollek K, Waliszewska-Prosół M, Wiels W, Boucherie DM, Onan D, Farham F, Al-Hassany L, Sacco S. Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis. J Headache Pain 2023; 24:8. [PMID: 36782182 PMCID: PMC9926688 DOI: 10.1186/s10194-023-01541-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce. MATERIAL AND METHODS We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8-18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted. RESULTS Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9-14%], 8% for migraine without aura (MwoA) [95%CI: 5-12%], 3% for migraine with aura (MwA) [95%CI:2-4%] and 17% for tension-type headache (TTH) [95% CI: 12-23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53-70%], with prevalence in females and males of 38% [95% CI: 16-66%] and 27% [95% CI: 11-53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking. CONCLUSION We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.
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Affiliation(s)
- Agnese Onofri
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Umberto Pensato
- Neurology and Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Humanitas University, Pieve Emanuele, Milan, Italy
| | - Chiara Rosignoli
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - William Wells-Gatnik
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Emily Stanyer
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Hui Zhou Chen
- Wolfson Centre for Age Related Diseases, King's College London, London, UK
| | - Federico De Santis
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Angelo Torrente
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Petr Mikulenka
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Gabriele Monte
- Department of Neuroscience, Neurology Unit, Bambino Gesù Children's Hospital, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Karol Marschollek
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Wietse Wiels
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Deirdre M Boucherie
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dilara Onan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Fatemeh Farham
- Department of Headache, Iranian Center of Neurological Researchers, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Linda Al-Hassany
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy.
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Güler Aksu G, Kayar O, Tufan AE, Kütük MÖ, Sucu DH, Taşdelen B, Toros F, Özge A. Early maladaptive schemas differing according to sex may contribute to migraine among the youth. Brain Dev 2022; 44:427-437. [PMID: 35459526 DOI: 10.1016/j.braindev.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 03/19/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Despite many diverse findings from studies about the comorbidity of psychiatric disorders and migraine, there are still unknown points. Schemas, which are the basic structures of cognition, are understudied. This study examined the effects of sex on early maladaptive schemas (EMSs) and the clinical characteristics of migraine in adolescents with migraine. METHODS The sample comprised 171 adolescents (67.3% females, n = 115) aged 12-18 years. The clinical characteristics of migraine (duration, severity, frequency of headaches, etc.), accompanying symptoms (nausea, vomiting, photophobia, etc.) and EMSs were evaluated depending on sex. Psychopathology and abuse history were analyzed as covariates in this study. RESULTS The mean age was 15.4 ± 1.9 among the females and 15.2 ± 2.0 among the males (p = 0.65). There was no difference in terms of migraine characteristics, and except for dizziness and pain relief by massage, all other symptoms were similar between the sexes. Female adolescent migraineurs significantly elevated scores for EMS of emotional deprivation, abandonment/instability, defectiveness/shame (disconnection/rejection domain), dependence/incompetence, vulnerability to harm/illness, failure (in impaired autonomy/performance domain) and negativity/pessimism (in hypervigilance/inhibition domain). On the other hand, male migraineurs had significantly elevated scores only in insufficient self-control/self-discipline (in impaired limits domain). Type of migraine and current psychopathology had no significant effect on the EMS domains, while sexual abuse history significantly affected some EMS. CONCLUSION Our study highlights the importance of screening for EMSs among adolescent patients with migraine. Schema therapy and similar therapeutic interventions may be used in the management of migraine in adolescents. Gender may also be important factor the schema therapy in adolescent migraine patients.
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Affiliation(s)
- Gülen Güler Aksu
- Department of Child and Adolescent Psychiatry, Mersin University School of Medicine, Mersin, Turkey.
| | - Ozan Kayar
- Department of Psychology, Çankırı Karatekin University, Çankırı, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Abant İzzet Baysal University, Bolu, Turkey
| | - Meryem Özlem Kütük
- Department of Child and Adolescent Psychiatry, Başkent University School of Medicine, Adana, Turkey
| | - Damla Hazal Sucu
- Department of Biostatistics and Medical Informatics, Mersin University School of Medicine, Mersin, Turkey
| | - Bahar Taşdelen
- Department of Biostatistics and Medical Informatics, Mersin University School of Medicine, Mersin, Turkey
| | - Fevziye Toros
- Department of Child and Adolescent Psychiatry, Mersin University School of Medicine, Mersin, Turkey
| | - Aynur Özge
- Department of Neurology, Mersin University School of Medicine, Mersin, Turkey
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