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Bonemazzi I, Nosadini M, Pelizza MF, Paolin C, Cavaliere E, Sartori S, Toldo I. Treatment of Frequent or Chronic Primary Headaches in Children and Adolescents: Focus on Acupuncture. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1626. [PMID: 37892289 PMCID: PMC10605007 DOI: 10.3390/children10101626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Acupuncture is a spreading and promising intervention, which has proven to be very useful in the treatment and prevention of chronic pain, in particular chronic headaches, in adults; the literature about the treatment of pediatric chronic headaches is scarce. In addition, few guidelines advise its use in children. The aim of this review is to collect all relevant studies with available data about the use, effect, and tolerability of acupuncture as a treatment for pediatric primary headaches. METHODS This is a narrative review based on eight studies selected from 135 papers including pediatric cases treated with acupuncture for headache. RESULTS Despite the differences in tools, procedures, and application sites, acupuncture demonstrated a positive effect on both the frequency and intensity of headaches and was well tolerated. There are no studies considering the long-term efficacy of acupuncture. CONCLUSION Further additional studies are needed on acupuncture in children and adolescents, with larger series and standardized procedures, in order to better assess efficacy, tolerability, and long-term prognosis and to define guidelines for the use of this promising and safe treatment. It is particularly relevant to identify safe and well-tolerated treatment options in pediatric patients affected by recurrent and debilitating headaches.
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Affiliation(s)
| | | | | | | | | | | | - Irene Toldo
- Juvenile Headache Center, Department of Woman’s and Child’s Health, University Hospital of Padua, 35128 Padua, Italy; (I.B.); (M.N.); (M.F.P.); (C.P.); (E.C.); (S.S.)
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Mangano GD, Capizzi MR, Mantuano E, Veneziano L, Santangelo G, Quatrosi G, Nardello R, Raieli V. Familial hemiplegic migraine in pediatric patients: A genetic, clinical, and follow-up study. Headache 2023. [PMID: 37326332 DOI: 10.1111/head.14582] [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: 12/06/2022] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim of this study was to describe a cohort of pediatric patients with genetically confirmed familial hemiplegic migraine (FHM). The knowledge of genotype-phenotype correlations may suggest prognostic factors associated with severe phenotypes. BACKGROUND Hemiplegic migraine is a rare disease and data concerning the pediatric population are even more rare as they are often extrapolated from mixed cohorts. METHODS We selected patients who met International Classification of Headache Disorders, third edition criteria for FHM, who had a molecular diagnosis, and whose first attack occurred under the age of 18 years. RESULTS We enrolled nine patients (seven males and two females) first referred to our three centers. Three of the nine (33%) patients had calcium voltage-gated channel subunit alpha1 A (CACNA1A) mutations, five (55%) had ATPase Na+/K+ transporting subunit alpha 2 (ATP1A2) mutations, and one had both genetic mutations. The patients experienced at least one aura feature other than hemiplegia during the first attack. The mean (SD) duration of HM attacks in the sample was 11.3 (17.1) h; 3.8 (6.1) h in the ATP1A2 group, and 24.3 (23.5) h in the CACNA1A group. The mean (SD, range) duration of follow-up was 7.4 (2.2, 3-10) years. During the first year from the disorder's onset, only four patients had additional attacks. Over the course of follow-up, the attack frequency overall was 0.4 attacks/year without a difference between the two groups (CACNA1A and ATP1A2). CONCLUSION The study data show that most of our patients with early-onset FHM experienced infrequent and non-severe attacks, which improved over time. Furthermore, the clinical course revealed neither the appearance of novel neurological disorders or a deterioration of basic neurological or cognitive functioning.
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Affiliation(s)
- Giuseppe Donato Mangano
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Maria Rita Capizzi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical, Specialities "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Elide Mantuano
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Liana Veneziano
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Giuseppe Santangelo
- Child Neuropsychiatry Department, P.O. Di Cristina, ARNAS Civico, Palermo, Italy
| | - Giuseppe Quatrosi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Rosaria Nardello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical, Specialities "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, P.O. Di Cristina, ARNAS Civico, Palermo, Italy
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Tou SI, Huang CY, Yen HR. Effect of Acupoint Stimulation on Controlling Pain from Heel Lance in Neonates: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1024. [PMID: 37371256 DOI: 10.3390/children10061024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
To evaluate the effect of acupoint stimulation compared to other interventions on pain control in neonates who underwent heel lance, we searched for randomized controlled trials across six databases (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, and Web of Science) published up to January 2023. Studies comparing acupoint stimulation and other interventions for controlling heel lance pain in neonates were included. These reports measured at least one of the following variables: pain score, crying time, oxygenation saturation, heart rate, respiration rate, and duration of the procedure. The data were independently extracted by two authors, and the PRISMA guidelines for study selection were followed. A total of 79 articles were screened, and 10 studies, with results on 813 neonates, were included in the final selection. The pain scores recorded during the heel lance procedure were not significantly different between the acupoint stimulation cohort and the control cohort (SMD of -0.26, 95% confidence interval (CI) from -0.52 to 0.01; p = 0.06; I2 = 68%). After processing the subgroup analyses, significant differences were found in the comparisons of acupuncture vs. usual care (SMD of -1.25, 95% CI from -2.23 to 0.27) and acupressure vs. usual care (SMD of -0.62, 95% CI from -0.96 to -0.28); nonsignificant differences were found in other comparisons. Our results demonstrate that acupoint stimulation may improve pain score during the heel lance procedure.
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Affiliation(s)
- Sio-Ian Tou
- Department of Pediatrics, Chung Kang Branch, Cheng-Ching General Hospital, Taichung 407, Taiwan
| | - Chia-Yu Huang
- Department of Family Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
| | - Hung-Rong Yen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
- International Master Program in Acupuncture, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan
- School of Post-Baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
- Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan
- Chinese Medicine Research Center, China Medical University, Taichung 404, Taiwan
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Correnti E, Lo Cascio S, Cernigliaro F, Rossi R, D'Agnano D, Grasso G, Pellegrino A, Lauria B, Santangelo A, Santangelo G, Tripi G, Versace A, Sciruicchio V, Raieli V. Idiopathic Non-Dental Facial Pain Syndromes in Italian Children: A Clinical Case Series. Life (Basel) 2023; 13:life13040861. [PMID: 37109390 PMCID: PMC10144764 DOI: 10.3390/life13040861] [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: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5-17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.
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Affiliation(s)
- Edvige Correnti
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
| | - Salvatore Lo Cascio
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Federica Cernigliaro
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Roberta Rossi
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Giulia Grasso
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Annamaria Pellegrino
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Barbara Lauria
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Andrea Santangelo
- Pediatrics Department, AOUP Santa Chiara Hospital, 56126 Pisa, Italy
| | | | - Gabriele Tripi
- Child Neuropsychiatry Unit Department, Pro.M.I.S.E. "G. D'Alessandro", University of Palermo, 90100 Palermo, Italy
| | - Antonella Versace
- Pediatric Headache Center, Pediatric Emergency Department, Regina Margherita Children's Hospital, 10126 Turin, Italy
| | - Vittorio Sciruicchio
- Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Department, ISMEP, ARNAS Civico, 90100 Palermo, Italy
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Gungor M, Guler MA, Karagoz YS. Management and behavior-modifying recommendation effects in childhood headache. Pediatr Int 2023; 65:e15406. [PMID: 36326638 DOI: 10.1111/ped.15406] [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: 07/01/2021] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Headaches are common in childhood. Recently, there has been an increasing trend toward pharmacological treatment. METHODS Secondary causes were excluded first in patients who attended our clinic with headache. Those without a secondary cause were evaluated as primary headache and classified into subgroups. Behavior-modifying recommendations (adequate and regular sleep, adequate and regular nutrition, adequate fluid intake, and restriction of screen exposure) were given to all patients. Patients were re-evaluated at 1, 3, and 6 months. Pharmacologic treatment was started at the end of the first month with follow-up at the third and sixth months for those who did not benefit from the behavior-modifying recommendations. RESULTS A total of 875 patients presented with headache complaints, of which 30.6% were evaluated as primary headache. Behavior-modifying recommendations were beneficial for 23.1% with migraine with aura; 20.3% with migraine without aura, and 36.8% with tension-type headache. CONCLUSION Secondary causes should be excluded first in patients who present to the pediatric neurology clinic with headache. Behavioral modifications to change the lifestyle of patients diagnosed with primary headache should be tried before giving pharmacologic treatment.
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Affiliation(s)
- Mesut Gungor
- Department of Pediatric Neurology, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Muhammet Akif Guler
- Department of Pediatrics, Ataturk University Medical Faculty, Erzurum, Turkey
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Song X, Wang J, Bai L, Zou W. Bibliometric Analysis of 100 Most Highly Cited Publications on Acupuncture for Migraine. J Pain Res 2023; 16:725-747. [PMID: 36923648 PMCID: PMC10010187 DOI: 10.2147/jpr.s396909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
Background Migraine is a serious global health concern that imposed a huge economic burden on social health care. Over the past few decades, the analgesic effects of acupuncture have been widely recognized, and there is a growing body of research on acupuncture for migraine. Citation analysis is a branch of bibliometrics that helps researchers analyze and identify historical or landmark studies within the scientific literature. Currently, there is no analysis of the 100 most highly cited publications on acupuncture for migraine. Methods The 100 most highly cited publications on acupuncture for migraine were screened using the Science Citation Index Expanded of the Web of Science Core Collection database. CiteSpace and VOSviewer programs were used for bibliometric analysis. Results A total of 493 publications on acupuncture for migraine were identified. 100 of the most highly cited publications on acupuncture for migraine were published from 1984-2020. These publications were cited 6142 times with an h-index of 44 and 84% were original articles. The highest frequency of citations was 416. A total of 335 authors were involved in the study with 37 lead authors. 212 institutions from 20 countries contributed to the 100 most highly cited publications. The most published studies came from the United States (n=36), followed by China (n=27) and Germany (n=26). The Technical University of Munich published the largest number of papers (n = 15). Top-cited publications mainly came from the Headache (n=13, citations=582). Neuroimaging is gradually emerging as a hot topic of research. Conclusion This is the first bibliometric analysis to offer a thorough list of the 100 most highly cited papers on acupuncture for migraine, demonstrating significant progress and emerging trends in this field to assist researchers in determining the direction for further research.
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Affiliation(s)
- Xue Song
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Jiaqi Wang
- The Second Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Lu Bai
- The First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, People's Republic of China
| | - Wei Zou
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People's Republic of China
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Miscioscia M, Di Riso D, Spaggiari S, Poli M, Gaiga G, Randazzo G, Pelizza MF, Galdiolo L, Raffagnato A, Sartori S, Toldo I. Emotional Experience and Regulation in Juvenile Primary Headaches: A Cross-Sectional Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1630. [PMID: 36360358 PMCID: PMC9688696 DOI: 10.3390/children9111630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 07/27/2023]
Abstract
A headache is the most common neurological symptom in children. Its subtypes are migraine (MH) and tension-type headache (TTH). Internalizing rather than externalizing symptoms are more frequent in children with headaches, but little is known about the reasons why. We aim to: (a) examine the interplay between emotional experience, affective regulation, and internalizing symptoms in children suffering from primary headaches and their caregivers; (b) identify potential predictors of children with migraines' internalizing symptoms. Fifty children and adolescents with a diagnosis of primary headaches and their caregivers were compared to a sample of fifty-one healthy peers and caregivers. Self-reports and parent-reports were administered. Results indicate higher negative affect and internalizing symptoms and lower bodily awareness of emotions in the clinical sample (n = 50; Mage = 11.66, SD = 2.25) compared to controls (n = 51; Mage = 11.73, SD = 2.32); mothers of TTH children self-reported lower emotional awareness and higher difficulties in engaging in goal-directed behavior; a higher frequency of headaches was associated with greater emotional regulation difficulties. Internalizing symptoms were predicted by higher self-reported negative affect and parent-reported internalizing symptoms, and lower self-reported ability in the verbal sharing of emotions. These findings suggest the importance of assessing the psychological features linked to children with primary headaches' psychological well-being.
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Affiliation(s)
- Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy
- Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padova, Italy
| | - Daniela Di Riso
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy
| | - Silvia Spaggiari
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy
| | - Mikael Poli
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy
| | - Giacomo Gaiga
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy
| | - Giacomo Randazzo
- Department of Developmental Psychology and Socialization, University of Padova, 35121 Padova, Italy
| | - Maria Federica Pelizza
- Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padova, Italy
- Juvenile Headache Center, Pediatric Neurology and Neurophysiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padua, 35128 Padova, Italy
| | - Laura Galdiolo
- Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padova, Italy
- Juvenile Headache Center, Pediatric Neurology and Neurophysiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padua, 35128 Padova, Italy
| | - Alessia Raffagnato
- Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padova, Italy
| | - Stefano Sartori
- Juvenile Headache Center, Pediatric Neurology and Neurophysiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padua, 35128 Padova, Italy
| | - Irene Toldo
- Juvenile Headache Center, Pediatric Neurology and Neurophysiology Unit, Department of Woman’s and Child’s Health, University Hospital of Padua, 35128 Padova, Italy
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Liampas I, Siokas V, Brotis A, Mentis AFA, Aloizou AM, Dastamani M, Tsouris Z, Lima M, Dardiotis E. Endogenous melatonin levels and therapeutic use of exogenous melatonin in tension type headache: A systematic review. Rev Neurol (Paris) 2021; 177:871-880. [PMID: 34167809 DOI: 10.1016/j.neurol.2021.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND-PURPOSE A bidirectional relationship appears to connect tension-type headache (TTH) and circadian dysregulation. The present systematic review examined the published evidence for melatonin (MT) supplementation in the prophylaxis of TTH. Initially, we reviewed case-control studies investigating nocturnal MT or 6-sulphatoxymelatonin (aMT6s, a urine-discarded metabolite) in TTH individuals and healthy controls (HC). Secondly, we reviewed studies appraising the use of MT in the prevention of TTH. METHODS The search strategy involved MEDLINE EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar and OpenGrey. Case-control studies were appraised according to the Newcastle-Ottawa-Scale, whereas randomised controlled trials were assessed based on the risk-of-bias Cochrane tool. Infrequent, as well as frequent, episodic, and chronic TTH patients were evaluated separately in children and adults. RESULTS Our search strategy yielded two case-control studies. One (high-quality) did not reveal any difference in morning salivary MT concentration between children with frequent episodic TTH and HC. The second (moderate-quality) was indicative of a disturbed nocturnal secretion pattern in adults with chronic TTH. For the second part, five uncontrolled studies were retrieved. In total, 94 adults with chronic TTH were assessed and results were suggestive of a beneficial effect of MT on headache frequency, intensity, induced disability, and induced analgesic consumption. However, the uncontrolled-unblinded designs may have induced an important placebo effect. Non-adult populations and frequent TTH were substantially understudied. CONCLUSIONS There are not enough studies to designate the role of MT in the prevention of TTH. Given the disease's background, additional relevant research is warranted for chronic TTH.
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Affiliation(s)
- I Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece.
| | - V Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece
| | - A Brotis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - A-F A Mentis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece; Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece
| | - A-M Aloizou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece
| | - M Dastamani
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece
| | - Z Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece
| | - M Lima
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece
| | - E Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Biopolis, Mezourlo Hill, 41100 Larissa, Greece
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Cook NE, Huebschmann NA, Iverson GL. Safety and Tolerability of an Innovative Virtual Reality-Based Deep Breathing Exercise in Concussion Rehabilitation: A Pilot Study. Dev Neurorehabil 2021; 24:222-229. [PMID: 33126815 DOI: 10.1080/17518423.2020.1839981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To examine the safety and tolerability of a virtual reality-based deep breathing exercise for children and adolescents who are slow to recover from concussion. Methods: Fifteen participants (ages 11 to 22; mean = 16.9 years) were recruited from a specialty concussion clinic within a tertiary care medical center. Participants completed a 5-min paced deep breathing exercise administered via a virtual reality headset. Results: Nearly all participants (93.3%) reported the experience was either positive or extremely positive. No participants reported significant discomfort or discontinued the exercise. Three participants reported a mild increase in headache, dizziness, or nausea. Participants reported significant decreases in stress (r =.57), tension (r =.73), fatigue (r =.73), and confusion (r =.67), with large effect sizes, following the deep breathing exercise. Conclusion: A brief, virtual reality-based deep breathing exercise is worthy of additional study as a rehabilitation component for children and adolescents with prolonged concussion recoveries.
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Affiliation(s)
- Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
| | - Nathan A Huebschmann
- Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Spaulding Research Institute, Charlestown, MA, USA.,MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA.,Center for Health and Rehabilitation Research, Charlestown, MA, USA
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10
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Liampas I, Siokas V, Brotis A, Vikelis M, Dardiotis E. Endogenous Melatonin Levels and Therapeutic Use of Exogenous Melatonin in Migraine: Systematic Review and Meta‐Analysis. Headache 2020; 60:1273-1299. [DOI: 10.1111/head.13828] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Ioannis Liampas
- Department of Neurology University Hospital of Larissa School of Medicine, University of Thessaly Larissa Greece
| | - Vasileios Siokas
- Department of Neurology University Hospital of Larissa School of Medicine, University of Thessaly Larissa Greece
| | - Alexandros Brotis
- Department of Neurosurgery University Hospital of Larissa School of Medicine, University of Thessaly Larissa Greece
| | - Michail Vikelis
- Headache Clinic Mediterraneo Hospital Glyfada Greece
- Glyfada Headache Clinic Glyfada Greece
| | - Efthimios Dardiotis
- Department of Neurology University Hospital of Larissa School of Medicine, University of Thessaly Larissa Greece
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11
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Bravaccio C, Terrone G, Rizzo R, Gulisano M, Tosi M, Curatolo P, Emberti Gialloreti L. Use of nutritional supplements based on melatonin, tryptophan and vitamin B6 (Melamil Tripto®) in children with primary chronic headache, with or without sleep disorders: a pilot study. Minerva Pediatr 2019; 72:30-36. [PMID: 31621274 DOI: 10.23736/s0026-4946.19.05533-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Headache is one of the main complaints in pediatric neurology. Exogenous melatonin has been shown to be useful and safe in improving sleep-wake cycles and sleep quality in children. Tryptophan as well plays a key role in sleep regulation. So far, no studies tried to analyze the effects of a combination of both melatonin and tryptophan in treating chronic headache in children affected also by night-time awakenings. METHODS Thirty-four children with a diagnosis of chronic headache (with or without sleep disorders) have been enrolled. The study was articulated in two steps: 1) each child was observed for one month without any intervention; 2) children have been then randomized into two groups: the "ME-group", which received the nutritional supplement melatonin for two months and the "MET-group", which received the nutritional supplements melatonin, tryptophan, and vitamin B6 for two months. RESULTS In terms of changes in number of headache events, responders in the ME-group were 91.7% and those in the MET-group were 66.7% (P=0.113). In terms of changes in number of night awakenings, in the ME group, mean number at baseline, after 30 days, and after 60 days were 3.6±3.2, 3.2±3.5, and 2.7±3.4 (P=0.495). In the MET group, mean number of night awakenings was 7.4±8.1, 4.0±4.4, and 3.3±2.9 (P=0.041). CONCLUSIONS Using either nutritional supplement for two months can help in decreasing the monthly number of headache episodes and night awakenings. The addition of tryptophan and vitamin B6 appears to have stronger influence on night awakenings reduction than melatonin only.
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Affiliation(s)
- Carmela Bravaccio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gaetano Terrone
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Renata Rizzo
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Mariangela Gulisano
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Michele Tosi
- Division of Child Neurology and Psychiatry, Department of Neurosciences, University Hospital of Tor Vergata, Rome, Italy
| | - Paolo Curatolo
- Division of Child Neurology and Psychiatry, Department of Neurosciences, University Hospital of Tor Vergata, Rome, Italy
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12
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Faedda N, Natalucci G, Baglioni V, Giannotti F, Cerutti R, Guidetti V. Behavioral therapies in headache: focus on mindfulness and cognitive behavioral therapy in children and adolescents. Expert Rev Neurother 2019; 19:1219-1228. [DOI: 10.1080/14737175.2019.1654859] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Noemi Faedda
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, “Sapienza” University, Rome, Italy
| | - Giulia Natalucci
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, “Sapienza” University, Rome, Italy
| | - Valentina Baglioni
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, “Sapienza” University, Rome, Italy
| | - Flavia Giannotti
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, “Sapienza” University, Rome, Italy
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology, “Sapienza” University, Rome, Italy
| | - Vincenzo Guidetti
- Department of Human Neuroscience, Section of Child and Adolescent Neuropsychiatry, “Sapienza” University, Rome, Italy
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13
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Peres MF, Valença MM, Amaral FG, Cipolla-Neto J. Current understanding of pineal gland structure and function in headache. Cephalalgia 2019; 39:1700-1709. [PMID: 31370669 DOI: 10.1177/0333102419868187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The pineal gland plays an important role in biological rhythms, circadian and circannual variations, which are key aspects in several headache disorders. OVERVIEW Melatonin, the main pineal secreting hormone, has been extensively studied in primary and secondary headache disorders. Altered melatonin secretion occurs in many headache syndromes. Experimental data show pineal gland and melatonin both interfere in headache animal models, decreasing trigeminal activation. Melatonin has been shown to regulate CGRP and control its release. DISCUSSION Melatonin has been used successfully as a treatment for migraine, cluster headaches and other headaches. There is a rationale for including the pineal gland as a relevant brain structure in the mechanisms of headache pathophysiology, and melatonin as a treatment option in primary headache.
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Affiliation(s)
- Mario Fp Peres
- Hospital Israelita Albert Einstein, Sao Paolo, Brazil.,Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Pernambuco, Brazil
| | | | | | - José Cipolla-Neto
- Instituto de Ciencias Biomédicas, Universidade de São Paulo, São Paulo, Brazil
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14
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Papetti L, Ursitti F, Moavero R, Ferilli MAN, Sforza G, Tarantino S, Vigevano F, Valeriani M. Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade? Front Neurol 2019; 10:771. [PMID: 31379721 PMCID: PMC6646427 DOI: 10.3389/fneur.2019.00771] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
Migraine is a frequent and very disabling disease, especially at pediatric age. Despite this, there are few controlled data on the prophylactic treatment of primary headaches in this category of age. Given that the recently introduced calcitonin gene-related peptide (CGRP) inhibitors (CGRP-r) are still limited to adulthood, there is no drug with exclusive indication for migraine treatment in pediatric age. This raises several limitations in terms of adherence and effectiveness of the therapy. Moreover, the scenario is complicated by placebo response, which is larger in children and adolescents than in adults and often leads to an improvement in the attack frequency even in absence of any active pharmacological treatment. Our aim was to investigate the real evidence concerning the prophylactic therapy of pediatric migraine by reviewing the clinical studies published between 2010 and 2019.
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Affiliation(s)
- Laura Papetti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Fabiana Ursitti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Romina Moavero
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy.,Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | | | - Giorgia Sforza
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome, Italy
| | - Samuela Tarantino
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Federico Vigevano
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Massimiliano Valeriani
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy.,Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
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15
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Nieswand V, Richter M, Berner R, von der Hagen M, Klimova A, Roeder I, Koch T, Sabatowski R, Gossrau G. The prevalence of headache in German pupils of different ages and school types. Cephalalgia 2019; 39:1030-1040. [DOI: 10.1177/0333102419837156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background/objective Headache in pupils is underestimated and has a negative impact on learning and life. The aim of this study was to investigate headache prevalence and its collateral effects, in pupils of different ages and school types in a German city. Methods Anonymized questionnaires were distributed to 5419 pupils attending primary and secondary schools. Demographics, headache frequency, analgesic use, school absence and, for secondary school children, data on lifestyle were collected. Results The questionnaire was returned by 2706 children (49%), 1362 (50.3%) girls, 1344 (49.7%) boys. Of these, 36.6% indicated a frequency of 1, and 31.5% a frequency of ≥ 2 headache days per month within the last 3 months. Headache prevalence increased with school grade, age and secondary school type: 63.6%, 67.2% and 79.5% for primary school children, pupils attending 8-year and pupils attending 6-year secondary schools, respectively. With secondary school level I certificates, pupils are prepared for general professional training in 6 years. Secondary school level II results, after 8 years of training, in university entrance level II certificates, which are the precondition for university studies. Girls reported significantly more headache than boys (73% vs. 63.1%). A significant relationship has been observed between headache frequency and school absence and between headache intensity and headache frequency. Of pupils with headache at least twice a month, 48.1% reported analgesic intake. Ibuprofen (49.1%) and paracetamol (32.8%) were the most frequently used analgesics. Of those pupils with headache ≥ 2 days/month, 68.3% did not have a specific headache diagnosis. Concomitant diseases and regular drug intake, analgesic intake for another reason than headache, caffeine consumption and lack of participation in sports were positively correlated with headache. Conclusions The majority of pupils suffer from headache at least once a month. Since frequent headache results in educational and social limitations, pupils at risk should be identified and referred to headache education programs. Efforts are needed to improve the management of juvenile headache patients.
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Affiliation(s)
- Vera Nieswand
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Matthias Richter
- Department of Pediatrics, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Maja von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Anna Klimova
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
- Institute for Medical Informatics and Biometrics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Ingo Roeder
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
- Institute for Medical Informatics and Biometrics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Rainer Sabatowski
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department of Anesthesiology and Intensive Care Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Gudrun Gossrau
- Pain Center, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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16
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Hypnotherapy or transcendental meditation versus progressive muscle relaxation exercises in the treatment of children with primary headaches: a multi-centre, pragmatic, randomised clinical study. Eur J Pediatr 2019; 178:147-154. [PMID: 30357468 PMCID: PMC6339662 DOI: 10.1007/s00431-018-3270-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 12/02/2022]
Abstract
Many children suffer from headaches. Since stress may trigger headaches, effective techniques to cope with stress are needed. We investigated the effectiveness of two mind-body techniques, transcendental meditation (TM) or hypnotherapy (HT), and compared them with progressive muscle relaxation (PMR) exercises (active control group). Children (9-18 years) suffering from primary headaches more than two times per month received either TM (N = 42), HT (N = 45) or PMR (N = 44) for 3 months. Primary outcomes were frequency of headaches and ≥ 50% reduction in headaches at 3 and 9 months. Secondary outcomes were adequate relief, pain coping, anxiety and depressive symptoms, somatisation and safety of treatment. Groups were comparable at baseline. Headache frequency was significantly reduced in all groups from 18.9 days per month to 12.5 and 10.5 at respectively 3 and 9 months (p < 0.001), with no significant differences between the groups. Clinically relevant headache reduction (≥ 50%) was observed in 41% and 47% of children at 3 and 9 months respectively, with no significant differences between the groups. No differences were observed in secondary outcome measures between the intervention groups. No adverse events were reported.Conclusion: All three techniques reduced primary headache in children and appeared to be safe.Trial registration: NTR 2955, 28 June 2011 ( www.trialregister.nl ) What is Known: • Stress may be an important trigger for both tension type headache and migraine in children. • Good data are lacking on the effect of transcendental meditation, hypnotherapy or progressive muscle relaxation as possible stress-reducing therapies in children with primary headaches. What is New: • Three non-pharmacological techniques, i.e., transcendental meditation, hypnotherapy and progressive muscle relaxation exercises, all result in a clinically significant reduction of headaches and use of pain medication. • No large differences between the three techniques were found, suggesting that children can choose either one of the three techniques based on personal preferences.
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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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18
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Sangermani R, Boncimino A. How to treat children with headache. Neurol Sci 2018; 39:107-108. [DOI: 10.1007/s10072-018-3375-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Foiadelli T, Piccorossi A, Sacchi L, De Amici M, Tucci M, Brambilla I, Marseglia GL, Savasta S, Verrotti A. Clinical characteristics of headache in Italian adolescents aged 11-16 years: a cross-sectional questionnaire school-based study. Ital J Pediatr 2018; 44:44. [PMID: 29618369 PMCID: PMC5885291 DOI: 10.1186/s13052-018-0486-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/26/2018] [Indexed: 12/16/2022] Open
Abstract
Background The purpose of this study was to determine headache characteristics, impact on daily activities and medication attitudes among a large sample of adolescents in Italy. Methods Secondary school classes were randomly selected from a national stratified multistage sampling. Data regarding socio-familial factors, headache characteristics, impact on daily activities and medication use were recorded with an anonymous multiple-choice questionnaire. Results The survey involved 2064 adolescents. 1950 questionnaires were considered for analysis. Study population included 944 males (48.4%) and 1006 females (51.6%), aged between 11 and 16 years (mean 13.5 ± 1.87). Headache prevalence was 65.9%. Mean age at headache onset was 8.33 years. 9.8% suffered from headache > 1/week, 14.3% > 1/month, 24.2% monthly and 17.7% less than monthly. The mean duration of a headache episode was less than 30 min in 32.9%, 1 hour in 28.1%, 2 hours in 19.3% and several hours in 19.5%. Pain intensity was moderate in 52.2% and severe in 9.5%. School represented the main trigger factor (67%). Impact on daily activities was noted in 57.5%. 69.2% of adolescents reported the use of pain relievers. Up to 5.7% declared self-medication, while only 20.6% followed a physician’s prescription. Female adolescents experienced headache more frequently (70.2% vs 60%) and more intensely than male peers. Girls had a higher family history of headache, could more frequently identify a trigger factor, and were more affected into their daily activities than boys. Conclusions Population-based studies of headache disorders are important, as they inform needs assessment and underpin service policy for a disease that is a public-health priority. Headache has a high prevalence among adolescents and carries a significant burden in terms of impact on daily activities and use of medication. Furthermore, underdiagnose is common, while trigger factors are often detectable. Special consideration should be given to female adolescents and self-medication attitudes.
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Affiliation(s)
- Thomas Foiadelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy.
| | - Alessandra Piccorossi
- Department of Pediatrics, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Mara De Amici
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | | | - Ilaria Brambilla
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Salvatore Savasta
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100, Pavia, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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20
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Messina A, Bitetti I, Precenzano F, Iacono D, Messina G, Roccella M, Parisi L, Salerno M, Valenzano A, Maltese A, Salerno M, Sessa F, Albano GD, Marotta R, Villano I, Marsala G, Zammit C, Lavano F, Monda M, Cibelli G, Lavano SM, Gallai B, Toraldo R, Monda V, Carotenuto M. Non-Rapid Eye Movement Sleep Parasomnias and Migraine: A Role of Orexinergic Projections. Front Neurol 2018. [PMID: 29541053 PMCID: PMC5835506 DOI: 10.3389/fneur.2018.00095] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction Sleep and migraine share a common pathophysiological substrate, although the underlying mechanisms are unknown. The serotonergic and orexinergic systems are both involved in the regulation of sleep/wake cycle, and numerous studies show that both are involved in the migraine etiopathogenesis. These two systems are anatomically and functionally interconnected. Our hypothesis is that in migraine a dysfunction of orexinergic projections on the median raphe (MR) nuclei, interfering with serotonergic regulation, may cause Non-Rapid Eye Movement parasomnias, such as somnambulism. Hypothesis/theory Acting on the serotonergic neurons of the raphe nuclei, the dysfunction of orexinergic neurons would lead to a higher release of serotonin. The activation of serotonergic receptors located on the walls of large cerebral vessels would lead to abnormal vasodilatation and consequently increase transmural pressure. This process could activate the trigeminal nerve terminals that innervate vascular walls. As a consequence, there is activation of sensory nerve endings at the level of hard vessels in the meninges, with release of pro-inflammatory peptides (e.g., substance P and CGRP). Within this hypothetical frame, the released serotonin could also interact with trigeminovascular afferents to activate and/or facilitate the release of the neuropeptide at the level of the trigeminal ganglion. The dysregulation of the physiological negative feedback of serotonin on the orexinergic neurons, in turn, would contribute to an alteration of the whole system, altering the sleep–wake cycle. Conclusion Serotonergic neurons of the MR nuclei receive an excitatory input from hypothalamic orexin/hypocretin neurons and reciprocally inhibit orexin/hypocretin neurons through the serotonin 1A receptor (or 5-HT1A receptor). Considering this complex system, if there is an alteration it may facilitate the pathophysiological mechanisms involved in the migraine, while it may produce at the same time an alteration of the sleep–wake rhythm, causing sleep disorders such as sleepwalking. Understanding the complex mechanisms underlying migraine and sleep disorders and how these mechanisms can interact with each other, it would be crucial to pave the way for new therapeutic strategies.
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Affiliation(s)
- Antonietta Messina
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ilaria Bitetti
- Clinic of Child and Adolescent Neuropsychiatry, Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Precenzano
- Clinic of Child and Adolescent Neuropsychiatry, Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Diego Iacono
- Neurodevelopmental Research Lab, Biomedical Research Institute of New Jersey (BRInj), Cedar Knolls NJ, United States.,Neuroscience Research, MidAtlantic Neonatology Associates, Atlantic Health System, Morristown NJ, United States.,Neuropathology Research, MidAtlantic Neonatology Associates (MANA) and Biomedical Research Institute of New Jersey (BRInj), Morristown, NJ, United States
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Lucia Parisi
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Margherita Salerno
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Agata Maltese
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Monica Salerno
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Rosa Marotta
- Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gabriella Marsala
- Struttura Complessa di Farmacia, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | - Christian Zammit
- Anatomy Department, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Francesco Lavano
- Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Beatrice Gallai
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Roberto Toraldo
- Clinic of Child and Adolescent Neuropsychiatry, Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Center for Childhood Headache, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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21
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Esposito M, Messina A, Monda V, Bitetti I, Salerno F, Precenzano F, Pisano S, Salvati T, Gritti A, Marotta R, Lavano SM, Lavano F, Maltese A, Parisi L, Salerno M, Tripi G, Gallai B, Roccella M, Bove D, Ruberto M, Toraldo R, Messina G, Carotenuto M. The Rorschach Test Evaluation in Chronic Childhood Migraine: A Preliminary Multicenter Case-Control Study. Front Neurol 2017; 8:680. [PMID: 29312117 PMCID: PMC5733029 DOI: 10.3389/fneur.2017.00680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/29/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECT About 1.2-3.2% of children at 7 years of age with increasing age up to 4-19% in adolescents are suffering from migraine without aura (MwA). The aim of the present study is investigating the personality style associated with children and adolescents affected by MwA, administrating the Rorschach test, and comparing with typical developing healthy controls (TD). METHODS 137 patients (74 males), aged 7.3-17.4 years (mean age 11.4, SD 3.02 years), affected by MwA according to the IHs-3 criteria. The Rorschach variables were treated as numerical variables and statistically tested with t-Student's analysis. RESULTS No statistical differences were found between the MwA and TD for age (p = 0.55), and gender (p = 0.804). From the comparison between the two samples, MwA group shows lower W responses (p < 0.001), good quality W responses (p < 0.001), high frequency of detailed responses (p < 0.001), the presence of even minor form of good quality responses (p < 0.001), increased presence of animals answers (A%) (p < 0.001), more frequent trivial answers (Ban%) (p < 0.001). DISCUSSION Rorschach interpretation pinpointed many interesting and, perhaps, peculiar aspects in our MwA population such as a trend predisposition for: analytical reasoning rather than synthetic, ease/practicality rather than creativity, oppositionality rather than external adaptation to the environment that may be interpreted as effect of general maladaptivity.
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Affiliation(s)
- Maria Esposito
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ilaria Bitetti
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Filomena Salerno
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Precenzano
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Simone Pisano
- Department of Child and Adolescent Neuropsychiatry, University of Salerno, Salerno, Italy
| | - Tiziana Salvati
- Faculty of Education Science, University Suor Orsola Benincasa of Naples, Naples, Italy
| | - Antonella Gritti
- Faculty of Education Science, University Suor Orsola Benincasa of Naples, Naples, Italy
| | - Rosa Marotta
- Department of Medical and Surgical Science, University Magna Graecia, Catanzaro, Italy
| | | | - Francesco Lavano
- Department of Health Sciences, University “Magna Graecia”, Catanzaro, Italy
| | - Agata Maltese
- Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy
| | - Lucia Parisi
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Margherita Salerno
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Gabriele Tripi
- Department PROSAMI, University of Palermo, Palermo, Italy
- Childhood Psychiatric Service for Neurodevelopmentals Disorders, Chinon, France
| | - Beatrice Gallai
- Centro per la Diagnosi e Cura dei Disturbi dell’apprendimento e del Comportamento Associazione per la ricerca scientifica Fusis, Alvignano, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Domenico Bove
- Centro per la Diagnosi e Cura dei Disturbi dell’apprendimento e del Comportamento Associazione per la ricerca scientifica Fusis, Alvignano, Italy
| | - Maria Ruberto
- Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Roberto Toraldo
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Marco Carotenuto
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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Xie Z, Wu H, Jing X, Li X, Li Y, Han Y, Gao X, Tang X, Sun J, Fan Y, Wen C. Hypouricemic and arthritis relapse-reducing effects of compound tufuling oral-liquid in intercritical and chronic gout: A double-blind, placebo-controlled, multicenter randomized trial. Medicine (Baltimore) 2017; 96:e6315. [PMID: 28296744 PMCID: PMC5369899 DOI: 10.1097/md.0000000000006315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/10/2017] [Accepted: 02/14/2017] [Indexed: 11/30/2022] Open
Abstract
TRIAL DESIGN In the double-blind, randomized, controlled trial, we aimed to evaluate the effects of compound tufuling oral liquid (CoTOL) on serum uric acid (sUA) levels and recurrence of acute gouty arthritis in intercritical and chronic gout treatment. METHODS A total of 210 patients with gout were screened from 8 hospitals to observe the sUA and acute gouty arthritis recurrence rate-reducing effects of CoTOL in intercritical and chronic gout during a 12-week treatment. We treated 139 and 71 patients with CoTOL and the placebo, respectively, and evaluated their sUA levels, acute gouty arthritis recurrence rate, and adverse events at week 0, 6, and 12. RESULTS Twenty-five and 12 patients in the treatment and control groups, respectively, had interrupted treatments, whereas 114 and 59 cases, respectively, completed their treatments. At the end of the 12-week treatment, the average decrease in sUA was 74.26 (95% confidence interval [CI]: 56.74-91.77 μmol/L) and 28.81 μmol/L (95% CI: 4.91-52.71 μmol/L) in the treatment and control groups, respectively (P = 0.004). The average decrease rate of sUA was 12.76% (95% CI: 9.82%-15.70%) and 4.57% (95% CI: 0.42%-8.71%) in the treatment and control groups, respectively (P = 0.004), and the gouty arthritis recurrence rate of the treatment group was lower than that of the control group (from week 6 to 12, 21.93% and 50.88% in the treatment and control group, respectively, P < 0.001; from baseline to week 12, 38.5% and 63.16%, respectively, P = 0.003). Severe adverse events were not observed in either groups, and fewer leucopenia incidences were observed in the treatment group than those in the control group (3/139 vs. 7/71, respectively, P = 0.033). CONCLUSION CoTOL reduced sUA levels and effectively prevented acute arthritis recurrence in intercritical and chronic gout without serious adverse events.
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Affiliation(s)
- Zhijun Xie
- College of Basic Medical Science, Zhejiang Chinese Medical University
| | - Huaxiang Wu
- Department of Rheumatism, The Second Affiliated Hospital of Zhejiang University Medical College
| | | | - Xiuyang Li
- Department of Public Health, Medical College, Zhejiang University
| | - Yasong Li
- Department of Rheumatism, Zhejiang People's Hospital
| | - Yongmei Han
- Department of Rheumatism, Sir Run Run Shaw Hospital of Zhejiang University Medical College
| | - Xiangfu Gao
- Department of Rheumatism, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou
| | - Xiaopo Tang
- Department of Rheumatism, Chinese Medical Academy Gate Hospital, Beijing
| | - Jing Sun
- Department of Rheumatism, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P.R. China
| | - Yongshen Fan
- College of Basic Medical Science, Zhejiang Chinese Medical University
| | - Chengping Wen
- College of Basic Medical Science, Zhejiang Chinese Medical University
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