Pediatric headache

Investigating the Frequency of Infantile Colic in Children with Migraine

Infantile colic is a common problem observed within the first 3 months of life in infants and is a common cause of crying among infants. Migraine is a common cause of recurrent primary headaches during childhood. The pathogenesis of migraine and colic has remained unknown, but various factors seem to be involved. Patients with migraine may have a medical history of infantile colic, and infantile colic is considered an early manifestation of migraine. In this study, we investigate the frequency of history of infantile colic in 6- to 14-year-old children with migraines. In this case–control study, 80 children with the diagnosis of migraine and 100 children without migraine, all within the age range of 6 to 14 years, were included. A checklist was completed for each person about the background information and history of infantile colic as well as the history of migraine in parents. Among the children with migraine, 92.5%, and in the control group, 10%, had a familial history of migraine. Also, among the children with migraine, 61.25%, and in the control group, 4%, had a history of infantile colic. The obtained results showed that the frequency of a history of infantile colic was significantly higher in the case group than in the control group. This study provides some evidence regarding the presence of association between infantile colic as well as the familial history of migraines and developing migraines in the future. However, due to some limitations of the retrospective manner of the study, the results should be completed with future studies.

Psychiatric comorbidity in childhood and adolescence headache

Primary headaches among children and adolescents have a substantial impact on quality of life, daily activities, social interaction, and school performance in combination with psychopathological symptoms. The main purpose of the present paper is to summarize clinical and epidemiological evidence for psychiatric comorbidity among children and adolescents with headaches, to describe how evidence in headache research suggest different pathways involved in the development and maintenance of these comorbid conditions, and finally suggest some elements professionals may find helpful to assess the scope of complaints, related functional impairment, and potential precipitating factors in planning of more targeted treatments.

Preventive drugs in childhood and adolescent migraine

While headaches in children are quite common, the study and characterization of headache disorders in the pediatric age group has historically been limited. In the absence of controlled studies on prophylactic treatment of the primary headache disorders in this age group, the diagnosis of childhood migraine rests on criteria similar to those in adults. Data from adult studies are often extrapolated and applied to children as well. Although it appears that many preventive agents are safe in children, none are currently FDA-approved for this age group. As a result, despite experiencing significant disability, the vast majority of children who present to their physician with migraine headache do not receive prophylactic therapy. Furthermore, controlled clinical trials investigating the use of both abortive and preventive medications in children have suffered from high placebo response rates. The shorter duration of headaches and other characteristic features seen in children are such that designing randomized controlled trials in this age group is more problematic and limiting. As such, treatment practices vary widely, even among specialists, due to the absence of evidence-based guidelines from clinical trials.

Butalbital and pediatric headache: stay off the downward path

Despite limited evidence from the literature surrounding safety or efficacy, butalbital-containing medicines (BCMs) have maintained their rank as "go-to" prescribed migraine and headache relief drugs in the United States, despite bans on these barbiturates in Germany and other European countries. Providers at the Pediatric Headache Program at Boston Children's Hospital recommend that clinicians prescribe triptan-based medications instead of BCMs, given the known negative side effects of BCMs on the general population, and the uncertain longitudinal trajectory of BCMs on developing brains.

Preventive effect of cyproheptadine hydrochloride in refractory patients with frequent migraine

Cyproheptadine hydrochloride (CH) is rarely used to treat adult patients with migraine in Japan because it causes sleepiness. In this study, we investigated the preventive effect of CH in 12 patients who had failed to respond to conventional preventive treatments among 103 migraine patients treated at our hospital. These 12 subjects had all received unsuccessful migraine prophylaxis with lomerizine, valproic acid and topiramate, or had discontinued these treatments due to adverse reactions. Initially, the subjects were given 4 mg CH before sleeping. In those who experienced no clinically significant sleepiness following the treatment, the drug was orally administered at 4 mg after breakfast as well (8 mg per day in total). Drug efficacy was evaluated by examining the frequency of migraine at one month and three months after the start of treatment. The frequency of migraine was dramatically reduced in all patients within 7 to 10 days after starting treatment. The average frequency of migraine during the three-month period was 2.6 episodes per month, representing a significant (p < 0.01) reduction from the pretreatment frequency of over 10 per month. Our results indicate that CH may be effective as a migraine-preventive treatment for patients in whom conventional drugs have been ineffective or have caused side effects. But this study is not a double blind randomized trial, and an open study with no control group.

Neuroimaging in childhood headache: a systematic review

Headache is a common complaint in children, one that gives rise to considerable parental concern and fear of the presence of a space-occupying lesion. The evaluation and diagnosis of headache is very challenging for paediatricians, and neuroimaging by means of CT or MRI is often requested as part of the investigation. CT exposes children to radiation, while MRI is costly and sometimes requires sedation or general anaesthesia, especially in children younger than 6 years. This review of the literature on the value of neuroimaging in children with headache showed that the rate of pathological findings is generally low. Imaging findings that led to a change in patient management were in almost all cases reported in children with abnormal signs on neurological examination. Neuroimaging should be limited to children with a suspicious clinical history, abnormal neurological findings or other physical signs suggestive of intracranial pathology. Well-designed prospective studies are needed to better define the clinical findings that warrant neuroimaging in children with headache.

Triptan use in pediatric migraine: focus on rizatriptan

Migraines are a common complaint in children and can cause a significant burden to both the child and their families, with a substantial loss in both school and work days, as well as having negative effects on the child’s self-esteem and peer relations. It has become clear that migraine-specific medications are needed in this population of patients and their use may result in a significant improvement of the child’s headaches and quality of life. Rizatriptan benzoate (Maxalt®) is a selective 5-hydroxytryptamine/serotonin1B/1D (5-HT1B/1D ) agonist that was approved by the US FDA in 1998 for the acute treatment of migraine attacks in adults. Despite having been widely used in the pediatric population, rizatriptan was most recently approved in December 2011 for pediatric use in children aged 6–17 years. The advantage of rizatriptan over some other triptans is its rapid onset of action, which is thought to be beneficial in the generally shorter migraine attacks of children when compared with adults. It may also be an appealing choice for young children because it comes in an orally disintegrating form for those who may have difficulty in swallowing tablets or who have significant gastrointestinal complaints accompanying their headaches, including nausea, vomiting and abdominal pain.

Migraine management: How do the adult and paediatric migraines differ?

Migraine is one of the common causes of severe and recurring headache. It may be difficult to manage in primary care settings, where it is under diagnosed and medically treated. Migraine can occur in children as well as in adults and it is three times more common in women than in men. Migraine in children is different from adults in various ways. Migraine management depends on the various factors like duration and severity of pain, associated symptoms, degree of disability, and initial response to treatment. The therapy of children and adolescents with migraines includes treatment modalities for acute attacks, prophylactic medications when the attacks are frequent, and biobehavioural modes of treatment to aid long-term management of the disorder. The long lasting outcome of childhood headaches and progression into adult headaches remains largely unknown. However, it has been suggested that adult migraine may represent a progressive disorder. In children, the progressive nature is uncertain and further investigations into longitudinal outcome and phenotypic changes in childhood headaches have yet to be recognized. Even though paediatric and adult migraines seem to be slightly different from one another, but not enough to categorize either as sole.