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Abu-Arafeh I. Predicting quality of life outcomes in children with migraine. Expert Rev Neurother 2022; 22:291-299. [PMID: 35263201 DOI: 10.1080/14737175.2022.2051481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Several studies have shown that the response of children with migraine to medications is suboptimum and inferior to the response reported in adults, despite the similar pathogenesis and biological mechanisms. The poor response may be related to the significant differences that make assessment and treatment of children with migraine more challenging than in adults. AREAS COVERED The purpose of this review is to discuss the whole process of assessment of children with migraine, the necessary skills for eliciting the clinical features, making the correct diagnosis and exploring lifestyle issues, co-morbid conditions (psychological and physical) and social influences on disease presentations. Also, to establish and address peculiarities of migraine in children that would enable clinicians to advise on lifestyle modifications, co-morbid conditions and the correct choice of treatment options including non-pharmacologic therapies and medications. EXPERT OPINION The choice of treatment should be based on an assessment of each individual child taking into account, age, gender, pubertal status, body weight, comorbid disorders and family history. Also considering the profile of migraine episodes, frequency, duration, associated symptoms and effects of nausea and vomiting. Using the appropriate medications in appropriate dosage, formulation and route and timing of administration may improve adherence to treatment and outcome.
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Affiliation(s)
- Ishaq Abu-Arafeh
- Paediatric Neurosciences Unit, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
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2
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Gazerani P. Migraine and Mood in Children. Behav Sci (Basel) 2021; 11:bs11040052. [PMID: 33919881 PMCID: PMC8070834 DOI: 10.3390/bs11040052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
Migraine is one of the most prevalent headache disorders in children and negatively influences their quality of life. Physical, social, and school functioning are negatively affected. Mood changes are common in migraineurs and may happen before, during, or after a migraine headache. Children with migraine are not exempt from mood swings. The majority of mood changes occur during the prodromal phase, manifesting as a psychobiological response, e.g., difficulty thinking, trouble concentrating, irritability, higher or lower energy, confusion, and depression. A bi-directional relationship between migraine and mood has been proposed, but mechanisms are not clear. Collectively, a maladaptive stress response has been suggested to explain the inability to balance homoeostatic changes when facing various stressors. Recognizing mood changes and monitoring mood patterns in children with migraine, for example, by various apps and so-called mood monitors, is valuable for better management. A multidisciplinary intervention has been recommended to reduce migraine disability, improve coping strategies, and reduce chronification risks in children with migraine. Pharmacological and non-pharmacological strategies are both available and effective. Biofeedback, relaxation, and cognitive-behavioral therapy yield positive outcomes in pediatric migraine. Developing healthy lifestyle habits (diet, exercise, sleep) also seems to improve migraine in this population.
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Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway;
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9229 Aalborg E, Denmark;
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3
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The Influence of Lifestyle Factors on the Burden of Pediatric Migraine. J Pediatr Nurs 2021; 57:79-83. [PMID: 33353788 DOI: 10.1016/j.pedn.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022]
Abstract
There is a gap in patient education and coaching of lifestyle factors related to pediatric migraine, which nurses are in a unique position to fill in order to provide comprehensive care to these patients. In order to help fill this gap, we conducted a targeted review of studies examining migraine and lifestyle factors in children and adolescents. Studies older than 2010, studies examining adults above the age of 18, studies not available in the English language, and secondary sources were excluded from the review. A final sample of 42 studies was included in this review. Lifestyle factors including stress, sleep, obesity, and diet were identified as playing a significant role in increasing the frequency, severity, and duration of migraine attacks in pediatric patients. Based on these findings, a framework is discussed for practical applications of this knowledge by nursing staff working in primary and specialty care clinics.
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4
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Global Burden of Headache Disorders in Children and Adolescents 2007-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010250. [PMID: 33396281 PMCID: PMC7795582 DOI: 10.3390/ijerph18010250] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/11/2022]
Abstract
Headache disorders are prevalent and disabling conditions impacting on people of all ages, including children and adolescents with substantial impact on their school activities and leisure time. Our study aims to report specific information on headaches in children and adolescents based on the Global Burden of Disease (GBD) study, that provides estimates for incidence, prevalence, fatal and non-fatal outcomes. We relied on 2007 and 2017 GBD estimates for prevalence and Years Lived with Disability (YLDs) at the global level and in WHO regions. The results show that, migraine and tension-type headache (TTH) together account for 37.5% of all-cause prevalence and for 7% of all-cause YLDs. Over the past decade, prevalence rates showed a mild increase of TTH in all ages and of migraine alone for adolescents. The YLDs increased among females of all ages with some regional differences that might be connected to the unequal availability of effective acute and prophylactic treatments across world regions. GBD data support the need to promote public health policies and strategies including diagnosis, pharmacological and non-pharmacological treatments that are expected to help reduce the disability and burden associated to migraine and TTH among children and adolescents.
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Raieli V, D'Amico A, Piro E. Migraine in Children Under 7 Years of Age: a Review. Curr Pain Headache Rep 2020; 24:79. [PMID: 33326057 DOI: 10.1007/s11916-020-00912-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Despite the accumulation of a significant amount of data on pediatric headache, few studies have been conducted on its occurrence in children under 7 years of age. Within primary headaches in this age, migraine especially, turns out to be a disorder affecting up to 4% of the general population. An underestimate of its true prevalence can be due to lack of specific diagnostic markers, the frequent difficulty of describing pain in childhood, and the necessity of reliable parents' reports. Thus, migraine in children under 7 years of age represents an important challenge for clinicians. The objective of this manuscript is to provide a comprehensive review of epidemiologic, clinic, and therapeutic aspects of migraine in this age. RECENT FINDINGS Current literature data show that migraine has some differences, especially in clinical and therapeutic terms, in this age group compared to subsequent ages. Furthermore, some evidences showing that an early onset of migraine may play an unfavorable role in its natural history, suggest an early identification and management of migraine in younger children. Moreover, we highlight the role that factors of prenatal and perinatal development can play in the predisposition and anticipation of migraine onset. Finally, open questions related to the several undefined features of migraine in this age are reported. Migraine in this pediatric population is absolutely not rare, represents an importan clinical challenge and probably has a negative predictive role.
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Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit- ISMEP -P.O. Cristina - ARNAS Civico, via dei Benedettini 1, Palermo, Italy.
| | - Antonina D'Amico
- Department for Health Promotion, Maternal Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro," Child Neuropsychiatry School, University Hospital "P. Giaccone", Via A. Giordano 3, 90127, Palermo, Italy
| | - Ettore Piro
- Department for Health Promotion, Maternal Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro," Neonatal Intensive Care Unit, University Hospital "P. Giaccone", Via A. Giordano 3, 90127, Palermo, Italy
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Yamanaka G, Morichi S, Suzuki S, Go S, Takeshita M, Kanou K, Ishida Y, Oana S, Kawashima H. A Review on the Triggers of Pediatric Migraine with the Aim of Improving Headache Education. J Clin Med 2020; 9:jcm9113717. [PMID: 33228144 PMCID: PMC7699367 DOI: 10.3390/jcm9113717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022] Open
Abstract
Although migraines are common in children and adolescents, they have a robustly negative impact on the quality of life of individuals and their families. The current treatment guidelines outline the behavioral and lifestyle interventions to correct common causative factors, such as negative emotional states, lack of exercise and sleep, and obesity; however, the evidence of their effectiveness is insufficient. To create a plan for disseminating optimal pediatric headache education, we reviewed the current evidence for factors correlated with migraine. We assessed three triggers or risk factors for migraines in children and adolescents: stress, sleep poverty, and alimentation (including diet and obesity). While there is a gradual uptick in research supporting the association between migraine, stress, and sleep, the evidence for diet-related migraines is very limited. Unless obvious dietary triggers are defined, clinicians should counsel patients to eat a balanced diet and avoid skipping meals rather than randomly limiting certain foods. We concluded that there is not enough evidence to establish a headache education plan regarding behavioral and lifestyle interventions. Clinicians should advise patients to avoid certain triggers, such as stress and sleep disorders, and make a few conservative dietary changes.
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Kornbluh AB, Thompson K, Mcmahen G, Rogers DL, Jordan CO, Aylward SC, Lehwald LM. Sleep disturbance in pediatric intracranial hypertension. J Clin Sleep Med 2020; 16:1099-1105. [DOI: 10.5664/jcsm.8436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Gada Mcmahen
- Department of Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - David L. Rogers
- Department of Ophthalmology, Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Shawn C. Aylward
- Department of Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lenora M. Lehwald
- Department of Neurology and Sleep Medicine, Nationwide Children’s Hospital, Columbus, Ohio
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Korabelnikova EA, Danilov AB, Danilov AB, Vorobyeva YD, Latysheva NV, Artemenko AR. Sleep Disorders and Headache: A Review of Correlation and Mutual Influence. Pain Ther 2020; 9:411-425. [PMID: 32621175 PMCID: PMC7648824 DOI: 10.1007/s40122-020-00180-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
The review is devoted to the complex relationship between headache and sleep disorders. The shared neuroanatomical structures of the nervous system involved in pain perception and sleep are shown, and mechanisms of comorbidity between headaches and sleep disorders are considered. Various types of headaches in the continuum of the sleep–wake cycle are described. Both pharmacological and non-pharmacological approaches to treatment are examined in detail, with the biochemical basis of the drug action.
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Affiliation(s)
- Elena A Korabelnikova
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Alexey B Danilov
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Andrey B Danilov
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yulia D Vorobyeva
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nina V Latysheva
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ada R Artemenko
- Department of Neurology, Institute for Postgraduate Education, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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9
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Tardov MV, Poluektov MG. [Sleep disorders in chronic pain syndromes]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 118:107-112. [PMID: 30059059 DOI: 10.17116/jnevro201811842107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sleep disorders and pain syndromes are widespread in the general population. This review presents data on comorbidity of these phenomena and possibility of their mutual influence on each other including data based on long-term prospective studies. Studies of pain syndromes and sleep disorders dynamics are analyzed in detail. Anatomical basis of sleep-pain interactions is described, and results of the emotional influence on sleep and pain associations are presented. Non-pharmacological and drug-based approaches to treatment with detailed description of the biochemical basis of their action are considered. The authors conclude that pain syndromes and sleep disorders have reciprocal relations; the improvement of sleep quality helps in various pain syndromes; sleep normalization could play a preventive role with regard to pain.
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Affiliation(s)
- M V Tardov
- State-financed Healthcare Institution of Moscow 'The Sverzhevskiy Otorhinolaryngology Healthcare Research Institute', Moscow, Russia
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10
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Orr SL, Turner A, Kabbouche MA, Horn PS, O'Brien HL, Kacperski J, LeCates S, White S, Weberding J, Miller MN, Powers SW, Hershey AD. Predictors of Short-Term Prognosis While in Pediatric Headache Care: An Observational Study. Headache 2019; 59:543-555. [PMID: 30671933 DOI: 10.1111/head.13477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To characterize the short-term prognosis of a clinical population of pediatric and young adult patients with migraine and explore predictors of clinical worsening while in care. METHODS This was a retrospective study of all migraine patients seen at the Cincinnati Children's Hospital Headache Center from 09/01/2006 to 12/31/2017, who had at least 1 follow-up visit within 1-3 months of the index visit analyzed. Included data were: age, sex, race, primary ICHD diagnosis, chronic migraine, medication overuse, history of status migrainosus, BMI percentile, headache frequency, headache severity, PedMIDAS score, allodynia, preventive treatment type, lifestyle habits, disease duration, depressive and anxiety symptoms. Clinical worsening was defined as an increase in 4 or more headache days per month between the index visit and the follow-up visit. RESULTS Data for 13,160 visit pairs (index and follow-up), from 5316 patients, were analyzed. Clinical worsening occurred in only 14.5% (1908/13,160), whereas a reduction in headache frequency was observed in 56.8% of visit intervals (7475/13,160), with 34.8% of the intervals (4580/13,160) showing a reduction of 50% or greater. The change in headache frequency was minimal (increase in 0-3 headaches/month) in 28.7% of intervals (3737/13,160). In the multivariable model, the odds of worsening were significantly higher with increasing age, female sex, chronic migraine, status migrainosus, depressive symptoms, higher PedMIDAS scores, and use of nutraceuticals, whereas the odds of worsening were lower for summer visits, caffeine drinkers, higher headache frequencies, and use of pharmaceuticals. CONCLUSIONS The majority of pediatric patients who receive multimodal interdisciplinary care for migraine improve over time. Our findings highlight a set of clinical features that may help in identifying specific factors that may contribute to an unfavorable short-term prognosis.
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Affiliation(s)
- Serena L Orr
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Abigail Turner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joanne Kacperski
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shannon White
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica Weberding
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mimi N Miller
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Abstract
PURPOSE OF REVIEW The current review presents findings from investigations of migraine in children. The presentation of pediatric migraine, related consequences, and medication treatments are reviewed. RECENT FINDINGS A number of advancements have been made in the study of the presentation, disability, and treatments for migraine in children. However, recent research suggests that not all approaches are equally effective in the treatment of migraine in children. Specifically, a recent study comparing pharmacological interventions found that preventive medications were not statistically more effective than placebo in children. Consistent findings showing clinically meaningful placebo response rates, shorter duration of headaches and other characteristic features (e.g. frontal, bilateral location) have been barriers to the design of randomized clinical trials in children and adolescents with migraine. Better understanding of treatment mechanisms for medication interventions is needed. SUMMARY Several migraine treatments have determined to be effective for use in children but few controlled studies have evaluated the effectiveness of medication treatments. Recent research suggests that preventive medications may not be more effective than placebo. Additional research is needed to evaluate the effectiveness of medication treatment in migraine headache care.
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12
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Ormond A, Faux BM, Zickefoose BA, Aden J, Kapunan PE, Roberts TA. Group Education and Multidisciplinary Management for Chronic Headaches Among Adolescents in a Military Treatment Facility: A Retrospective Chart Review. Headache 2018; 58:570-578. [PMID: 29411353 DOI: 10.1111/head.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of group education on the frequency of chronic headaches among adolescents. BACKGROUND Chronic headaches are a common problem among adolescents with significant psychosocial morbidity. Brief education on lifestyle interventions to decrease headache frequency has established benefits among adult patients but is less proven among adolescents. METHODS This study is a chart review examining our experience with a group education program for 155 adolescents, aged 12-17 years old, enrolled in the U.S. military medical system with at least 3 months of chronic headaches who were referred to a headache evaluation clinic. The primary outcome of our study was self-reported number of days with a headache in the previous 30 days based on patient recall. We used a paired samples t-test to measure the change in headache frequency between the frequency reported at the headache class and follow-up more than 6 months after the class. RESULTS Most of the adolescents seen in the program were female (114/155 [73.5%]) and suffered from migraine headaches (108/155 [69.8%]). Severe headache-related disability was reported by 40.6% of subjects (63/155). Subjects reported an average of 19 days with headache during the previous 30 days. Females and patients with higher headache-related disability reported a higher number of days with headache. Participation in the group education was associated with an 11.5 (SD 11.9, P < .001) day decrease in the frequency of headaches during the previous 30 days at follow-up at least 6 months after the class, with largest decline seen in patients with the highest level of migraine-related disability at baseline. CONCLUSION Based on our retrospective chart review study, group education on headache evaluation and lifestyle management has potential as an effective, low-cost intervention for treatment of chronic headaches among adolescents.
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Affiliation(s)
- Andrew Ormond
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Brian M Faux
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Betty A Zickefoose
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - James Aden
- Department of Biostatistics and Epidemiology, Institute of Surgical Research, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Patricia E Kapunan
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Timothy A Roberts
- Pediatrics Department, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, USA
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Langhagen T, Landgraf MN, Huppert D, Heinen F, Jahn K. Vestibular Migraine in Children and Adolescents. Curr Pain Headache Rep 2016; 20:67. [DOI: 10.1007/s11916-016-0600-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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14
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Faedda N, Cerutti R, Verdecchia P, Migliorini D, Arruda M, Guidetti V. Behavioral management of headache in children and adolescents. J Headache Pain 2016; 17:80. [PMID: 27596923 PMCID: PMC5011470 DOI: 10.1186/s10194-016-0671-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 08/20/2016] [Indexed: 02/06/2023] Open
Abstract
Headache is the most frequent neurological symptom and the most prevalent pain in children and adolescents, and constitutes a serious health problem that may lead to impairment in several areas. Psychosocial factors, social environment, life events, school and family stressors are all closely related to headaches. A multidisciplinary strategy is fundamental in addressing headache in children and adolescents. Applying such a strategy can lead to reductions in frequency and severity of the pain, improving significantly the quality of life of these children. It has been demonstrated that behavioral intervention is highly effective, especially in the treatment of paediatric headache, and can enhance or replace pharmacotherapy, with the advantage of eliminating dangerous side effects and or reducing costs. Behavioral interventions appear to maximize long-term therapeutic benefits and improve compliance with pharmacological treatment, which has proven a significant problem with child and adolescent with headache. The goal of this review is to examine the existing literature on behavioral therapies used to treat headache in children and adolescents, and so provide an up-to-date picture of what behavioral therapy is and what its effectiveness is.
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Affiliation(s)
- Noemi Faedda
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108, 00185, Rome, Italy
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Paola Verdecchia
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108, 00185, Rome, Italy
| | - Daniele Migliorini
- Department of Computer, Control and Management Engineering Antonio Ruberti, Sapienza University of Rome, Rome, Italy
| | - Marco Arruda
- Glia Institute, Ribeirão Preto, São Paulo, Brazil
| | - Vincenzo Guidetti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Via dei Sabelli, 108, 00185, Rome, Italy.
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15
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Kacperski J, Kabbouche MA, O’Brien HL, Weberding JL. The optimal management of headaches in children and adolescents. Ther Adv Neurol Disord 2016; 9:53-68. [PMID: 26788131 PMCID: PMC4710107 DOI: 10.1177/1756285615616586] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The recognition of the diagnosis of migraine in children is increasing. Early and aggressive treatment of migraine in this population with the use of over-the-counter medications has proven effective. The off-label use of many migraine-specific medications is often accepted in the absence of sufficient evidenced-based trials. Mild to severe cases of migraine should be treated with nonsteroidal anti-inflammatory drugs, with triptans used in moderate to severe headaches unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine [DHE] should be used for status migrainosus, preferably in the hospital setting. Antiemetics that have antidopaminergic properties can be helpful in patients with associated symptoms of nausea and vomiting through their action on central migraine generation. Furthermore, patients and families should be educated on nonpharmacologic management such as lifestyle modification and avoidance of triggers that can prevent episodic migraine.
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Affiliation(s)
- Joanne Kacperski
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnett Avenue, Cincinnati, OH 45229, USA
| | - Marielle A. Kabbouche
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hope L. O’Brien
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica L. Weberding
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Abstract
The interaction between sleep and headache or migraine is powerful and an elevated comorbidity between these 2 disorders has been reported in either adults or children. This comobidity is linked to common neurophysiological and neuroanatomical substrates that are genetically based strongly. The first reports on this relationship were related to the prevalence of parasomnias and sleep-disordered breathing in headache but recent research has expanded the comorbidity to several other sleep disorders, such as restless legs syndrome, periodic limb movements during sleep, and narcolepsy. The assessment of children with headache should always include an accurate anamnesis for the presence of sleep problems either in the child or in the relatives; no correct approach for treating children and adolescents is possible without an integrated method of evaluation and management.
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Affiliation(s)
- Claudia Dosi
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Mariagrazia Figura
- Department of Clinical and Experimental Medicine University of Messina, Messina, Italy; Oasi Research Insitute IRCCS, Troina, Italy
| | | | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.
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Abstract
While it has been established that headaches in the pediatric age group are relatively common, the characterization of headache disorders and their treatment in this group has historically been limited. Due to the paucity of controlled studies on prophylaxis of the primary headache disorders in children, the diagnosis of migraine often rests on criteria similar to those used in adults. Data from adult studies are often extrapolated and applied to the pediatric patient. Although it appears that many prophylactic agents are safe, well tolerated and efficacious in children, currently only topiramate is FDA-approved for use in patients 12 years and over. As a result, despite often experiencing significant disability, many children who present to their physician with migraines do not receive preventive therapy. One-third of adolescents meet the criteria for warranting prophylactic therapy, yet few are offered a preventative medication. Moreover, controlled clinical trials investigating the use of both abortive and prophylactic medications in children have suffered from high placebo response rates. A diverse group of medications are used to prevent migraine attacks, including antidepressants, antiepileptics, antihistamines and antihypertensive agents, yet there still remains a serious lack of controlled studies on the pharmacological treatment of pediatric migraine.
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Affiliation(s)
- Joanne Kacperski
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave-MLC 2015, Cincinnati, OH, 45229-3039, USA,
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18
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O'Brien HL, Kabbouche MA, Kacperski J, Hershey AD. Treatment of pediatric migraine. Curr Treat Options Neurol 2015; 17:326. [PMID: 25617222 DOI: 10.1007/s11940-014-0326-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OPINION STATEMENT The diagnosis of migraine in the pediatric population is increasing as providers are becoming more familiar with recognizing the condition. Over-the-counter and migraine-specific treatment, once considered off-label, have proven to be effective, especially if given at the early onset of head pain. Mild to severe cases of migraine should be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), with triptans used alone or in combination in moderate to severe headaches unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine (DHE), a potent vasoconstrictor should be used for intractable migraines and is preferred in the hospital setting. Anti-emetics that have anti-dopaminergic properties can be helpful in patients with associated symptoms of nausea and vomiting along with headache, especially when used in combination therapy. Preventative treatment should be initiated early in patients with frequent headaches to improve headache outcomes and quality of life. Patients and families should be educated on non-pharmacologic management, such as lifestyle modification and avoidance of triggers, that can prevent progression and worsening of migraine.
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Affiliation(s)
- Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA,
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Abstract
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.
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Faria V, Linnman C, Lebel A, Borsook D. Harnessing the placebo effect in pediatric migraine clinic. J Pediatr 2014; 165:659-65. [PMID: 25063720 PMCID: PMC4358740 DOI: 10.1016/j.jpeds.2014.06.040] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/27/2014] [Accepted: 06/11/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Vanda Faria
- Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Clas Linnman
- Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alyssa Lebel
- Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA; Chronic Headache Program, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA; Chronic Headache Program, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Guidetti V, Dosi C, Bruni O. The relationship between sleep and headache in children: implications for treatment. Cephalalgia 2014; 34:767-76. [PMID: 24973419 DOI: 10.1177/0333102414541817] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The existence of a correlation and/or comorbidity between sleep disorders and headache, related to common anatomical structures and neurochemical processes, has important implications for the treatment of both conditions. METHODS The high prevalence of certain sleep disorders in children with migraine and the fact that sleep is disrupted in these patients highlight the importance of a specific therapy targeted to improve both conditions. FINDINGS The treatment of sleep disorders like insomnia, sleep apnea, sleep bruxism and restless legs syndrome, either with behavioral or pharmacological approach, often leads to an improvement of migraine. Drugs like serotoninergic and dopaminergic compounds are commonly used for sleep disorders and for migraine prophylaxis and treatment: Insomnia, sleep-wake transition disorders and migraine have been related to the serotonergic system abnormality; on the other hand prodromal symptoms of migraine (yawning, drowsiness, irritability, mood changes, hyperactivity) support a direct role for the dopaminergic system that is also involved in sleep-related movement disorders. CONCLUSIONS Our review of the literature revealed that, beside pharmacological treatment, child education and lifestyle modification including sleep hygiene could play a significant role in overall success of the treatment. Therefore comorbid sleep conditions should be always screened in children with migraine in order to improve patient management and to choose the most appropriate treatment.
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Affiliation(s)
| | - Claudia Dosi
- Department of Developmental and Social Psychology, Sapienza University, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Italy
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Dosi C, Riccioni A, Corte MD, Novelli L, Ferri R, Bruni O. Comorbidities of sleep disorders in childhood and adolescence: focus on migraine. Nat Sci Sleep 2013; 5:77-85. [PMID: 23788845 PMCID: PMC3684219 DOI: 10.2147/nss.s34840] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The correlation and/or comorbidity between sleep disorders and headache has been reported in numerous studies, but the exact nature of the association between headache, disordered sleep, and underlying mechanisms remains poorly understood. The bidirectional association between sleep and headache is mediated by a temporal link (headache occurs during sleep, after sleep, and in relationship with sleep stages), by a quantitative relationship (excess, lack, bad quality, short duration of sleep may trigger headache), and by a reciprocal connection (headache may cause sleep disruption and may be associated with several sleep disturbances). This association is most evident for primary headache disorders, especially in childhood. A congenital alteration of neurotransmitter pathways (serotoninergic and dopaminergic) might predispose individuals to both disorders, presenting as sleep-wake rhythm disorder in infancy or as headache disorder later in childhood, as result of this neurotransmitter imbalance. Clinicians should be aware that a complete clinical evaluation of childhood headache includes a careful sleep history, taking into account that the treatment of sleep disturbances could lead to an improvement of headache symptoms and vice versa.
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Affiliation(s)
- Claudia Dosi
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Assia Riccioni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Martina della Corte
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Luana Novelli
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
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Eidlitz-Markus T, Dlugatch Y, Haimi-Cohen Y, Goldberg-Stern H, Zeharia A. Nonpharmacologic treatment of migraine with low-dose propranolol or amitriptyline. Pediatr Neurol 2012; 46:345-9. [PMID: 22633628 DOI: 10.1016/j.pediatrneurol.2012.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/26/2012] [Indexed: 11/27/2022]
Abstract
This study evaluated the effectiveness of nonpharmacologic measures combined with low-dose propranolol or amitriptyline for treating severe pediatric migraine. Data were collected from the medical files of 118 patients (mean age, 12.54 ± 3.14 years S.D.). All were treated with nonpharmacologic measures. In addition, 93 children received propranolol (mean initial dose, 0.4 ± 0.17 mg/kg/day S.D.), and 25 received amitriptyline (mean initial dose, 0.26 ± 0.1 mg/kg/day S.D.). Twenty patients were switched from propranolol to amitriptyline during treatment. In both groups, headache frequency was reduced by >50% per month in ~80% of patients. Patients without aura responded significantly better to propranolol than patients with aura (P = 0.02). No significant difference was evident in response to pharmacologic treatment by migraine frequency or type (episodic chronic). No significant difference was evident in response to amitriptyline between patients with or without aura. The response rate was higher than previously reported for placebo. Low-dose propranolol and low-dose amitriptyline, when combined with nonpharmacologic measures, are equally effective in reducing the frequency of migraine in children. Propranolol is preferred because of its lower risk of side effects. An additive effect of nonpharmacologic measures may allow for a reduction in drug dose.
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Affiliation(s)
- Tal Eidlitz-Markus
- Ambulatory Day Hospitalization Center, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
OPINION STATEMENT The recognition of the diagnosis of migraine in the pediatric population is increasing. Early and aggressive treatment of migraine in children and adolescents with the use of over-the-counter medications has proven effective. In addition, the off-label use of many migraine-specific medications is often accepted in the absence of sufficient evidence-based trials. Mild to severe cases of migraine should be treated with NSAIDs, with triptans used for moderate to severe headaches that are unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine (DHE) should be used for intractable migraines, preferably in the hospital setting. In patients with associated symptoms of nausea and vomiting, antiemetics with antidopaminergic properties can be helpful through their action on central migraine generation. Furthermore, patients and families should be educated about nonpharmacologic aspects of management such as preventing episodic migraine through lifestyle modification and avoidance of triggers.
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Pompili M, Serafini G, Innamorati M, Serra G, Dominici G, Fortes-Lindau J, Pastina M, Telesforo L, Lester D, Girardi P, Tatarelli R, Martelletti P. Patient outcome in migraine prophylaxis: the role of psychopharmacological agents. PATIENT-RELATED OUTCOME MEASURES 2010; 1:107-18. [PMID: 22915957 PMCID: PMC3417910 DOI: 10.2147/prom.s9742] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Migraine is a serious illness that needs correct treatment for acute attacks and, in addition, a treatment prophylaxis, since patients with migraine suffer during acute attacks and also between attacks. METHODS A systematic review of the most relevant clinical trials of migraine headache and its epidemiology, pathophysiology, comorbidity, and prophylactic treatment (medical and nonmedical) was carried out using "Medline" and "PsychINFO" from 1973 to 2009. Approximately 110 trials met our inclusion criteria and were included in the current review. RESULTS The most effective pharmacological treatment for migraine prophylaxis is propranolol and anticonvulsants such as topiramate, valproic acid, and amitriptyline. Nonmedical treatments such as acupuncture, biofeedback, and melatonin have also been proposed. Peripheral neurostimulation has been suggested for the treatment of chronic daily headache that does not respond to prophylaxis and for the treatment of drug-resistant primary headache. The majority of the pharmacological agents available today have limited efficacy and may cause adverse effects incompatible with long-term use. LIMITATIONS The review was limited by the highly variable and often insufficient reporting of the complex outcome data and by the fact that migraine prophylaxis trials typically use headache diaries to monitor the course of the disease. The results of the different studies were also presented in different ways, making comparison of the results difficult. DISCUSSION An adequate prophylaxis is crucial in reducing disability and preventing the evolution of the problem into a chronic progressive illness. The implications of the present findings were discussed.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
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Millichap JG. Dietary Treatment for Migraine Under Six Years. Pediatr Neurol Briefs 2009. [DOI: 10.15844/pedneurbriefs-23-11-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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