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Monteith TS, Stark-Inbar A, Shmuely S, Harris D, Garas S, Ironi A, Kalika P, Irwin SL. Remote electrical neuromodulation (REN) wearable device for adolescents with migraine: a real-world study of high-frequency abortive treatment suggests preventive effects. Front Pain Res (Lausanne) 2023; 4:1247313. [PMID: 38028429 PMCID: PMC10657883 DOI: 10.3389/fpain.2023.1247313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Migraine is a chronic neurological disease manifesting as attacks of disabling head pain and associated symptoms. Remote electrical neuromodulation (REN) is a non-pharmacological, prescribed, wearable device (Nerivio®). This device has been certified by the FDA for the acute and/or preventive treatment of migraine with or without aura in patients 12 years of age or older. The device is affixed to the user's arm during 45-min treatment sessions and is operated using a smartphone app. This study (NCT05769322) aims to evaluate whether frequent use of REN for the acute treatment of migraine in adolescents resulted in a reduction in monthly migraine treatment days (MMTD), as previously demonstrated in adults through a dedicated prevention clinical trial (NCT04828707). Methods The study included real-world prospective data from adolescent patients who used REN on at least 10 days every 28-day month, following the REN migraine prevention guideline of an every-other-day pattern. Additional requirements were at least three REN treatment days in each of the two subsequent months. The number of MMTD was used as a proxy measure for the number of monthly migraine days (MMD). The change in MMTD from the first month, taken as a "baseline," to each of the following months was used to evaluate the presence and size of potential migraine preventive benefits of REN in adolescents. Results A total of 83 adolescents were eligible for analysis. The users were 15.9 ± 1.3 years of age (mean ± SD), and 89% of them were female. The results demonstrated a substantial month-to-month reduction in the mean (±SD) number of REN treatment days from 12.6 (±3.2) MMTD in the first month to 9.0 (±4.8) MMTD in the second month (p < 0.001), and a further decrease to 7.4 (±4.2) MMTD in the third month (p < 0.001). This indicates an accumulative reduction of 5.2 (±4.8) mean REN MMTD from the first month to the third month of consecutive REN treatment. The users also reported consistent 2-h acute pain responses in at least 50% of their treated attacks, with 61.9% of the users reported experiencing pain relief, 24.5% reported pain freedom, 67.4% indicated relief in functional disability, and 41.3% reported complete freedom from functional disability. Conclusion The frequent use of REN among adolescents as an acute treatment for migraine attacks resulted in a decrease in the mean number of monthly treatment days in the subsequent months, suggesting that REN may have potential preventive benefits for migraine in this subpopulation.
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Affiliation(s)
| | | | - Sharon Shmuely
- Clinical Development Department, Theranica, Netanya, Israel
| | - Dagan Harris
- Clinical Development Department, Theranica, Netanya, Israel
| | - Sandy Garas
- Clinical Development Department, Theranica, Netanya, Israel
| | - Alon Ironi
- Clinical Development Department, Theranica, Netanya, Israel
| | - Paige Kalika
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Samantha L. Irwin
- Department of Neurology, UCSF Benioff Children’s Hospitals, San Francisco, CA, United States
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2
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Zorrilla N, Gelfand AA, Irwin SL. Eptinezumab for adolescents with chronic refractory headache: A retrospective chart review. Headache 2023; 63:177-182. [PMID: 36633118 DOI: 10.1111/head.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of eptinezumab for the treatment of chronic refractory headache in adolescents. BACKGROUND Chronic refractory headache can lead to school absences and impaired quality of life in adolescents, and currently there are no pharmacologic treatments with level A evidence for headache prevention for this population. While observational data suggest that monoclonal antibodies to calcitonin gene-related peptide or its receptor may be helpful for adolescents who have refractory primary headache disorders, evidence is lacking for the use of eptinezumab. METHODS This was a single-center, retrospective chart review. Demographic and headache phenotypic data were collected. Outcome measures included headache intensity and frequency pre- and post-infusion(s), and improvement in function or in associated symptoms. Adverse events were also collected. RESULTS Nine patients with chronic migraine and two with new daily persistent headache received a first dose of 100 mg of eptinezumab. All of them had daily headache and nine had continuous headache at baseline. After the first infusion of 100 mg, two patients were no longer having daily headache, one patient stopped having continuous headache, and four patients noted headache intensity reduction. Additionally, one patient described a reduction in nausea and vomiting, and another patient noted improvement in function. Six patients received a second eptinezumab infusion of 100 mg, three had a third one, and one patient had four infusions of 100 mg. After the second infusion, one patient noted reduction in headache frequency, one experienced lower headache intensity, and two described pain "improving." With the third and fourth infusions, patients continued to report improvement in headache intensity. Subsequent infusions of 300 mg resulted in further reductions in headache frequency and intensity for some patients. Eptinezumab was overall well tolerated. CONCLUSION While this was a small sample, findings suggest that eptinezumab may be a safe and effective treatment for chronic, refractory headache in adolescents.
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Affiliation(s)
- Natalia Zorrilla
- UCSF Child and Adolescent Headache Program, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Amy A Gelfand
- UCSF Child and Adolescent Headache Program, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Samantha L Irwin
- UCSF Child and Adolescent Headache Program, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
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3
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Irwin SL, Greene KA, Pavitt SJ, Ross AC. Headache in the Pediatric Population: Focus on Migraine. Semin Neurol 2022; 42:479-488. [DOI: 10.1055/s-0042-1757927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPediatric headache is a common condition with significant impact on quality of life and ability to function in academic, social, and extracurricular activities. Most pediatric patients seen in primary care and neurology clinics with headache have primary headache disorders. Diagnosis is largely based on clinical history. Imaging is rarely needed in the absence of red flag features. Careful diagnosis is important to guide appropriate treatment. Treatment focuses on a biopsychosocial model integrating lifestyle, pharmacologic and nonpharmacologic treatment modalities. As few therapies are approved in the pediatric population, treatments are often used off-label based on evidence extrapolated from adult studies. Outcomes vary over time but are generally favorable when headache disorders are diagnosed promptly and managed in a multidisciplinary setting.
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Affiliation(s)
- Samantha L. Irwin
- Department of Neurology, University of California, San Francisco (UCSF), California
| | - Kaitlin A. Greene
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, Oregon
| | - Sara J. Pavitt
- Department of Neurology, University of Texas, Austin, Texas
| | - Alexandra C. Ross
- Department of Pediatrics, University of California, San Francisco (UCSF), California
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4
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Patterson Gentile C, Shah R, Irwin SL, Greene K, Szperka CL. Acute and chronic management of posttraumatic headache in children: A systematic review. Headache 2021; 61:1475-1492. [PMID: 34862612 DOI: 10.1111/head.14236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The goal of this paper is to provide a compilation of the evidence for the treatment of posttraumatic headache (PTH) in the pediatric population. Headache features and timing of therapy were considered. BACKGROUND Headache is the most common symptom following mild traumatic brain injury (mTBI), affecting more than 80% of children and adolescents. It is unclear whether treatment for PTH should be tailored based on headache characteristics, particularly the presence of migraine features, and/or chronicity of the headache. METHODS Systematic literature searches of PubMed, Embase, Scopus, and Cochrane databases (1985-2021, limited to English) were performed, and key characteristics of included studies were entered into RedCAP® (Prospero ID CRD42020198703). Articles and conference abstracts that described randomized controlled trials (RCTs), cohort studies, retrospective analyses, and case series were included. Participants included youth under 18 years of age with acute (<3 months) and persistent (≥3 months) PTH. Studies that commented on headache improvement in response to therapy were included. RESULTS Twenty-seven unique studies met criteria for inclusion describing abortive pharmacologic therapies (9), preventative pharmacotherapies (5), neuromodulation (1), procedures (5), physical therapy and exercise (6), and behavioral therapy (2). Five RCTs were identified. Studies that focused on abortive pharmacotherapies were completed in the first 2 weeks post-mTBI, whereas other treatment modalities focused on outcomes 1 month to over 1-year post-injury. Few studies reported on migrainous features (7), personal history of migraine (7), or family history of migraine (3). CONCLUSIONS There is limited evidence on the timing and types of therapies that are effective for treating PTH in the pediatric population. Prospective studies that account for headache characteristics and thoughtfully address the timing of therapies and outcome measurement are needed.
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Affiliation(s)
- Carlyn Patterson Gentile
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Shah
- School of Arts and Sciences, University of Richmond, Richmond, Virginia, USA
| | - Samantha L Irwin
- UCSF Child & Adolescent Headache Program, San Francisco, California, USA
| | - Kaitlin Greene
- Doernbecher Children's Hospital Child and Adolescent Headache Program, Division of Pediatric Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Christina L Szperka
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Gelfand AA, Ross AC, Pavitt S, Szperka CL, Irwin SL, Bertisch S, Stone KL, Frazier R, Grimes B, Allen IE. Would chronotype change the impact of the relationship between early school schedules and adolescent migraine frequency? A response. Headache 2021; 61:404-405. [PMID: 33544394 DOI: 10.1111/head.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 12/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Amy A Gelfand
- Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra C Ross
- Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Pavitt
- Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA
| | - Christina L Szperka
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Samantha L Irwin
- Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA
| | - Suzanne Bertisch
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katie L Stone
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Remi Frazier
- Academic Research Systems, University of California, San Francisco, CA, USA
| | - Barbara Grimes
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - I Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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Greene KA, Gentile CP, Szperka CL, Yonker M, Gelfand AA, Grimes B, Irwin SL. Calcitonin Gene-Related Peptide Monoclonal Antibody Use for the Preventive Treatment of Refractory Headache Disorders in Adolescents. Pediatr Neurol 2021; 114:62-67. [PMID: 33232919 PMCID: PMC7770043 DOI: 10.1016/j.pediatrneurol.2020.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Monoclonal antibodies to calcitonin gene-related peptide or its receptor have clinical trial evidence in adults with headache, but data are lacking in adolescents. The objective of this study was to describe the safety and efficacy of calcitonin gene-related peptide monoclonal antibody treatment in adolescents with chronic headache disorders. METHODS We performed a retrospective multisite cohort study of patients less than 18 years of age who received a calcitonin gene-related peptide monoclonal antibody for headache prevention. Demographics, baseline headache characteristics, efficacy, and side effect data were collected. RESULTS The study population comprised 112 adolescents who received at least one dose of a calcitonin gene-related peptide monoclonal antibody. Mean (S.D.; range) age at first dose was 15.9 years (1.4; 10.3 to 17.8). Ninety-four patients (83.9%) had chronic migraine, 12 (10.7%) had new daily persistent headache, and six (5.4%) had persistent post-traumatic headache. At baseline, the mean (S.D.) number of headache days per month was 26.9 (6.1) (n = 109) and headache was continuous in 75 of 111 (67.6%). At first follow-up visit there was a significant reduction in headache frequency compared with baseline (-2.0 days; 95% confidence interval, -0.8 to -3.2). Significant benefit was perceived by 29.5% of patients at first follow-up visit (n = 33/112) and 30.1% (n = 22/73) at second follow-up visit. A significant functional improvement was perceived by 31% of patients (n = 31/94) at the first follow-up visit and 22.4% (n = 15/67) at the second follow-up visit. The most common side effects were injection site reactions in 17.0% (n = 19) and constipation in 8.0% (n = 9). Five patients (4.5%) discontinued because of side effects. CONCLUSIONS Side effects with calcitonin gene-related peptide monoclonal antibody treatment in adolescents were similar to those reported in adult trials. Calcitonin gene-related peptide monoclonal antibody treatment appears to benefit a proportion of adolescents with chronic refractory headache disorders.
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Affiliation(s)
- Kaitlin A Greene
- Division of Pediatric Neurology, Department of Pediatrics, Oregon Health Sciences University, Portland, Oregon
| | - Carlyn P Gentile
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina L Szperka
- Pediatric Headache Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marcy Yonker
- Pediatric Headache Program, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Amy A Gelfand
- Child and Adolescent Headache Program, University of California, San Francisco, California
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Samantha L Irwin
- Child and Adolescent Headache Program, University of California, San Francisco, California.
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7
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Gelfand AA, Pavitt S, Ross AC, Szperka CL, Irwin SL, Bertisch S, Stone KL, Frazier R, Grimes B, Allen IE. Later high school start time is associated with lower migraine frequency in adolescents. Headache 2020; 61:343-350. [PMID: 33237581 DOI: 10.1111/head.14016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether high school start time is associated with headache frequency in adolescents with migraine. BACKGROUND Adolescence is marked by a physiologic delayed circadian phase, characterized by later bedtimes and wake times. The American Academy of Pediatrics (AAP) recommends that high schools start no earlier than 8:30 a.m., but most high schools in the United States start earlier. The study hypothesis was that adolescents with migraine whose high schools start at 8:30 a.m. or later (late group) would have lower headache frequency than those whose schools start earlier than 8:30 a.m. (early group). METHODS This was a cross-sectional Internet survey study of US high schoolers with migraine recruited online through social media. Comparisons were made between the late group and the early group. The primary outcome measure was self-reported headache days/month. RESULTS In total, 1012 respondents constituted the analytic set: n = 503 in the late group versus n = 509 in the early group. Mean (SD) self-reported headache days/month was 4.8 (4.6) versus 7.7 (6.1) in the late and early groups, respectively (p < 0.001); mean difference -2.9 (95% CI -2.2 to -3.6). Mean (SD) self-reported hours of sleep on a school night was 7.9 (0.9) versus 6.9 (1.3), p < 0.001. Adjusting for total hours of sleep, sex, taking a migraine preventive, days of acute medication use, hours of homework, grade level, and missing breakfast, mean (SD) self-reported headache days/month remained lower in the late group than in the early group: 5.8 (95% CI 5.3-6.2) versus 7.1 (95% CI 6.7-7.4), (p < 0.001); mean difference -1.3 (95% CI -1.9 to -0.7). CONCLUSION Adolescents with migraine who attend high schools that follow AAP recommendations for start times have lower self-reported headache frequency than those whose high schools start before 8:30 a.m. If prospective studies confirm this finding, shifting to a later high school start time may be an effective strategy for migraine prevention in adolescents.
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Affiliation(s)
- Amy A Gelfand
- Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Pavitt
- Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra C Ross
- Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA
| | - Christina L Szperka
- Division of Neurology, Children's Hospital of Philadelphia & Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Neurology, Children's Hospital of Philadelphia & Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Samantha L Irwin
- Child & Adolescent Headache Program, University of California, San Francisco, San Francisco, CA, USA
| | - Suzanne Bertisch
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katie L Stone
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.,Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Remi Frazier
- Academic Research Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Barbara Grimes
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - I Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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8
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Orr SL, Gelfand AA, Hranilovich J, Irwin SL, Kabbouche M, Lagman-Bartolome AM, Lavell C, O'Brien HL, Rajapakse T, Rao R, Szperka C, Werner K, VanderPluym J, Yonker M, Hershey A. The Development of the Medical Transfer Packet for Transition of Care of the Pediatric Patient with Headache. Headache 2020; 60:2589-2591. [PMID: 32969505 DOI: 10.1111/head.13948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Serena L Orr
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy A Gelfand
- UCSF Child & Adolescent Headache Program, San Francisco, CA, USA
| | | | - Samantha L Irwin
- UCSF Child & Adolescent Headache Program, San Francisco, CA, USA
| | - Marielle Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Cheryl Lavell
- Mountain Consulting Pediatrics, Hamilton, ON, Canada
| | - Hope L O'Brien
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thilinie Rajapakse
- Department of Pediatrics, Faculty of Medicine and Dentistry, Edmonton, AB, Canada.,Stollery Children's Hospital, Edmonton, AB, Canada.,Women and Children's Research Institute, Edmonton, AB, Canada
| | - Rashmi Rao
- Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Christina Szperka
- Pediatric Headache Program, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Klaus Werner
- Division of Pediatric Neurology, Duke University Medical Center, Durham, NC, USA
| | | | - Marcy Yonker
- Department of Pediatrics, Division of Child Neurology, Children's Hospital Colorado, University of Colorado, CO, USA
| | - Andrew Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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9
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Gelfand AA, Ross AC, Irwin SL, Greene KA, Qubty WF, Allen IE. Melatonin for Acute Treatment of Migraine in Children and Adolescents: A Pilot Randomized Trial. Headache 2020; 60:1712-1721. [DOI: 10.1111/head.13934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Amy A. Gelfand
- Department of Neurology UCSF Child & Adolescent Headache Program San Francisco CA USA
| | - Alexandra C. Ross
- Department of Pediatrics UCSF Child & Adolescent Headache Program San Francisco CA USA
| | - Samantha L. Irwin
- Department of Neurology UCSF Child & Adolescent Headache Program San Francisco CA USA
| | - Kaitlin A. Greene
- Division of Pediatric Neurology Department of Pediatrics Oregon Health & Science University Portland OR USA
| | - William F. Qubty
- Pediatric Headache Program Dell Medical School University of Texas at Austin Austin TX USA
| | - I. Elaine Allen
- Department of Epidemiology & Biostatistics University of California San Francisco San Francisco CA USA
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10
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Irwin SL, Kacperski J, Rastogi RG. Pediatric Post‐Traumatic Headache and Implications for Return to Sport: A Narrative Review. Headache 2020; 60:1076-1092. [DOI: 10.1111/head.13824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Samantha L. Irwin
- Department of Neurology University of California San Francisco San Francisco CA USA
| | - Joanne Kacperski
- Division of Neurology Cincinnati Children's Hospital Medical Center Cincinnati OH USA
- Department of Pediatrics College of Medicine University of Cincinnati Cincinnati OH USA
| | - Reena G. Rastogi
- Department of Neurology Barrow Neurological Institute at Phoenix Children's Hospital Phoenix AZ USA
- Department of Neurology University of Arizona College of Medicine Phoenix AZ USA
- Department of Child Health University of Arizona College of Medicine Phoenix AZ USA
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Abstract
Children and teenagers with migraine are often advised to live a life of perfect balance-to sleep regularly and well, to eat breakfast each day, to drink plenty of water, and to exercise religiously. The logic is that doing so will decrease their migraine frequency. The corollary that follows is that failing to follow such advice will result in the patient continuing to experience migraine at its current frequency. This opens the door to potentially blaming the patients for their migraine and contributing to migraine stigma. This article reviews the current state of the evidence for each of these behavioral interventions for migraine prevention, and provides the clinician with practical advice for counseling patients.
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Affiliation(s)
- Amy A Gelfand
- Department of Neurology, Child and Adolescent Headache Program, University of California, San Francisco, San Francisco, California
| | - Samantha L Irwin
- Department of Neurology, Child and Adolescent Headache Program, University of California, San Francisco, San Francisco, California
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12
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Abstract
This article outlines key features of diagnosis and treatment of migraine in children and adolescents. It emphasizes techniques that can be used by clinicians to optimize history taking in this population, as well as recognition of episodic conditions that may be associated with migraine and present in childhood. Acute treatment strategies include use of over-the-counter analgesics and triptan medications that have been approved by the US Food and Drug Administration for use in children and adolescents. Preventive treatment approach includes lifestyle modifications, behavioral strategies, and consideration of preventive medications with the lowest side effect profiles.
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Affiliation(s)
- Kaitlin Greene
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA
| | - Samantha L Irwin
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA
| | - Amy A Gelfand
- Department of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall Box 0137, 550 16th Street, 4th Floor, San Francisco, CA 94158, USA.
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13
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Irwin SL, Qubty W, Allen IE, Patniyot I, Goadsby PJ, Gelfand AA. Transcranial Magnetic Stimulation for Migraine Prevention in Adolescents: A Pilot Open-Label Study. Headache 2018. [PMID: 29528485 DOI: 10.1111/head.13284] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess the feasibility, tolerability, and patient acceptability of single-pulse transcranial magnetic stimulation (sTMS) for migraine prevention in adolescents in an open-label pilot study. BACKGROUND Migraine is common in adolescents and can be disabling. Well tolerated preventative therapies that are safe and effective are needed. METHODS This was an open-label prospective pilot feasibility study of sTMS for migraine prevention in adolescents aged 12-17 years. Participants used sTMS twice daily in a preventative fashion, as well as additional pulses as needed acutely. A 4-week baseline run-in period (weeks 1-4) was followed by a 12-week treatment period. Feasibility was the primary outcome. Secondary outcomes included tolerability and acceptability, as well as the change in headache days, number of moderate/severe headache days, days of acute medication use, and PedMIDAS (headache disability) scores between the run-in period (weeks 1-4) and the third month of treatment (weeks 13-16). RESULTS Twenty-one participants enrolled. Nineteen completed the baseline run-in, and 12 completed the study. Using sTMS proved feasible and acceptable with overall high compliance once treatment administration was streamlined. Initially, for preventive treatment, participants were asked to give 2 pulses, wait 15 minutes, then give 2 additional pulses twice daily. This 15-minute delay proved challenging for adolescents, particularly on school days, and therefore was dropped. Study completion rate went from 4/13 (31%) to 7/8 (88%) once this change was made, P = .024. On average, participants used the device preventively between 22 and 24 days over a 28-day block. There were no serious adverse events. Two participants reported mild discomfort with device use. CONCLUSION sTMS appears to be a feasible, well-tolerated, and acceptable nonpharmacologic preventive treatment for migraine in adolescents. In designing future trials of sTMS for migraine prevention in adolescents, streamlined treatment administration will be essential to minimize drop-out. Efficacy needs to be assessed in a larger trial.
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Affiliation(s)
- Samantha L Irwin
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - William Qubty
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - I Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Irene Patniyot
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Peter J Goadsby
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA.,NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Amy A Gelfand
- Department of Neurology, University of California, San Francisco (UCSF), San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco (UCSF), San Francisco, CA, USA
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Affiliation(s)
- S L Irwin
- Alfred I duPont Hospital for Children, Wilmington, Delaware, USA.
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Abstract
Synthetic genes were designed to encode analogs of the two proteins of Nephila clavipes dragline silk, spidroins 1 and 2. The genes were constructed of tandem repeats of relatively long (more than 300 bp) DNA sequences assembled from synthetic oligonucleotides, and encoded proteins of high molecular mass (65-163 kDa). Both analogs were produced efficiently in Escherichia coli. The yield and homogeneity of the products of longer genes were limited by premature termination of synthesis, probably as a result of processivity errors in protein synthesis. Average termination rates were determined to be 1 in 1100 codons to 1 in 300 codons, depending on the length and synonymous codon choices of the gene. Both analog proteins could be induced to form stable aqueous solutions without denaturants. Circular dichroism spectra of the purified proteins in dilute solution resembled spectra of redissolved natural dragline silk in reflecting a largely disordered structure in water and more ordered structures in mixed solvents with methanol and trifluoroethanol.
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Affiliation(s)
- S R Fahnestock
- Central Science and Engineering Laboratories, E.I. DuPont de Nemours & Co., Wilmington, DE 19880-0328, USA.
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