Anxiety and Depressive Symptoms and Disorders in Children and Adolescents With Migraine

Falla, Katherine; Kuziek, Jonathan; Mahnaz, Syeda Rubbia; Noel, Melanie; Ronksley, Paul E.; Orr, Serena L.

doi:10.1001/jamapediatrics.2022.3940

Cited by 26 publications

(49 citation statements)

References 96 publications

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“…Mechanism by which this therapy works in not fully understood but believed to be related to its ability to decrease intracranial pressure. Other small case series have shown some benefit with agents such as topiramate, methysergide, propranolol, naproxen and IV metoclopramide (1). Our patient's headache meets the diagnostic criteria for primary cough headache and has shown marked improvement in both frequency and intensity of headaches following onabotulinum toxin therapy.…”

Section: Discussionmentioning

confidence: 56%

“…The International Headache Society defines primary cough headache as a headache, precipitated by coughing or straining in the absence of any intracranial disorder lasting up to 30 minutes (1). The etiology of primary cough headaches is believed to be related to elevated intracranial pressure which results from the increased central venous pressure that occurs with coughing (1,3).…”

Section: Discussionmentioning

confidence: 99%

“…Buxton T 1,2 , Wang M 3 , Huebner M 1,4 , Dorricott N 5 , Tutt J 5 , Duong T 1 , Flinn H 1 , Greenway A 1,2,4 , Russo A 1,4,6 , Sowers L 4,7 years has indicated that multiple brain regions and brain system functions are involved in migraine, but how activity is coordinated across these regions in migraine is not understood. Several preclinical mouse models of migraine have been developed that manifest phenotypes with increased sensory hypersensitivity such as photophobia and allodynia.…”

Section: Medial Nucleusmentioning

confidence: 99%

“…Shane B 1 , Durojaye S 1 , Alshawa A 1 , Van Orden K 1 , Vera Tudela E 1 , Chhina G 1 , Sandhu S 1 1 The University of Arizona College of Medicine -Tucson, Tucson, United States This case describes an interesting presentation of glossopharyngeal neuralgia (GN) complicated by undiagnosed idiopathic intracranial hypertension (IIH) and migraines, while also discussing the importance of nerve and vessel imaging to aid in treating GN.…”

Section: Idiopathic Intracranial Hypertension and Migrainesmentioning

confidence: 99%

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American Headache Society 65^th Annual Scientific Meeting June 15‐18, 2023 Austin, Texas

2023

Headache

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Based on a critical evaluation of whether clinically relevant pharmacokinetic or pharmacodynamic drug-drug interactions (DDIs) can occur between INP104 and gepants for migraine treatment, no DDIs of clinical concern were predicted when recommended clinical doses of INP104 and gepants are coadministered. Background: Nasally administered dihydroergotamine mesylate (DHE; INP104) and orally administered gepants are approved migraine therapies. DHE has broad receptor coverage (serotonergic, adrenergic, and dopaminergic), while gepants are calcitonin generelated peptide (CGRP) receptor antagonists. It is likely that INP104 and gepants will be coadministered; however, no clinical studies investigating possible DDIs between these agents exist. The objective of this study was to predict whether coadministration of INP104 and gepants for migraine management results in potential drug-drug interactions (DDIs). Methods: This was a critical evaluation for potential pharmacokinetic or pharmacodynamic DDIs between INP104 and atogepant, rimegepant, or ubrogepant. Quantitative predictions were assessed according to methods/criteria from current regulatory authority guidelines on in vitro DDIs. These predictions and their ability to sufficiently rule out clinically relevant interactions based on available data from applicable documents and publications were assessed. Whether DHE is an inhibitor/inducer of DDIs or is inhibited/induced by DDIs was also investigated. Results: All three gepants are principally cleared by hepatic metabolism and are sensitive substrates of CYP3A4, suggesting that gepant pharmacokinetics is potentially influenced by CYP3A4 inhibitors/inducers. DHE is not an in vitro inhibitor of CYP3A4 activity. Clinically relevant in vivo DDIs arising from inhibition of hepatic/gastrointestinal CYP3A4 by DHE can be excluded. DHE is principally cleared by hepatic metabolism and is considered a CYP3A4 substrate; coadministration of potent CYP3A4 inhibitors with DHE is contraindicated. None of the three gepants is a potent inhibitor/inducer of CYP3A4. Data exclude clinically relevant DDIs from hepatic/gastrointestinal metabolic inhibition by gepants or from nasal metabolic inhibition of DHE. No clinically relevant DDIs from inhibition of, or being a substrate for, transporter proteins by gepants or DHE are anticipated because of limited data, but cannot be excluded. Conclusion: Based on available data, no DDIs of clinical concern are predicted when recommended clinical doses of INP104 and gepants are coadministered.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Medial Nucleusmentioning

confidence: 99%

Section: Idiopathic Intracranial Hypertension and Migrainesmentioning

confidence: 99%

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American Headache Society 65^th Annual Scientific Meeting June 15‐18, 2023 Austin, Texas

2023

Headache

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“…In recent meta-analyses of published studies, children and adolescents with migraine were shown to be more likely to have anxiety symptoms and disorders as well as depressive symptoms and disorders than healthy children and adolescents. Interestingly, the same results were seen in clinical and community/population-based samples, and there was no evidence of publication bias [ 41 ].…”

Section: Predictors Of Psychological Comorbidities Of Headache In Chi...mentioning

confidence: 59%

Headache and Psychological Comorbidities: An Appraisal of the Evidence

Abu‐Arafeh

2023

JCM

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Background: It has been observed that there is a higher-than-expected risk of anxiety and depression in children with chronic headache and also an increased risk for the persistence of headache in patients with anxiety and depression. Objectives: This review aims to identify and assess the relationships between primary headache disorders and comorbid emotional and psychological disorders. Methods: A targeted review of the literature was carried out. Results: The associations between the disorders are more pronounced in clinic patients, who may represent the severe end of the headache spectrum, but less clear in patients who were identified in population-based studies and who may represent the “average” child with headache or the “average” child with psychological disorders. Conclusions: Understanding this bidirectional association of comorbid disorders is of great importance to offering a holistic biopsychosocial approach to the management of headache disorders in children and adolescents and in addressing the risks for and the co-existence of psychological comorbidities.

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Preventive Medications in Pediatric Migraine

Kohandel Gargari,

Aghajanian,

Togha

et al. 2024

JAMA Netw Open

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ImportancePediatric migraine substantially impacts quality of life and academic performance among children and adolescents. Understanding the efficacy and safety of pharmacological interventions for migraine prophylaxis in this population is crucial for developing effective treatment strategies.ObjectiveTo conduct a comprehensive network meta-analysis to evaluate the efficacy and safety associated with pharmacological treatments for pediatric migraine prophylaxis among pediatric patients with a migraine diagnosis and assess interventions involving various oral pharmacological interventions compared with each other and placebo.Data SourcesPubMed, Embase, and SCOPUS were searched for publications up to September 2023. Search terms and indexing were chosen to encompass relevant studies, focusing on randomized clinical trials in pediatric migraine prophylaxis.Study SelectionInclusion criteria targeted randomized clinical trials involving pediatric patients with migraine. Studies were selected based on their examination of oral pharmacological interventions. The search yielded an initial 9162 citations.Data Extraction and SynthesisData extraction adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Five investigators independently extracted study data into a spreadsheet in duplicate. Study-level estimates were calculated, employing a random-effects model for primary and secondary outcomes due to identified heterogeneity. Data analysis was conducted from December 2023 to March 2024Main Outcomes and MeasuresThe primary outcome was migraine frequency (number of attacks per month). Secondary outcomes included a 50% or greater responder rate, headache duration, headache intensity, and disability (assessed by pediatrics migraine-specific disability tool). Adverse events were also evaluated.ResultsThe analysis incorporated 45 trials with 3771 participants. Compared with placebo, pregabalin (ratio of means [RoM], 0.38; 95% CI, 0.18-0.79) and topiramate with vitamin D3 (RoM, 0.44; 95% CI, 0.30-0.65) were associated with reduction in migraine frequency. Flunarizine (RoM, 0.46; 95% CI, 0.26-0.81), levetiracetam (RoM, 0.47; 95% CI, 0.30-0.72), riboflavin (RoM, 0.50; 95% CI, 0.32-0.77), cinnarizine (RoM, 0.64; 95% CI, 0.46-0.88), topiramate (RoM, 0.70; 95% CI, 0.55-0.89), and amitriptyline (RoM, 0.73; 95% CI, 0.54-0.97) were also associated with reduction in migraine frequency, but these findings were drawn from individual studies. For the 50% or greater responder rate, flunarizine and α-lipoic acid (risk ratio [RR], 8.73; 95% CI, 2.44-31.20), flunarizine (RR, 4.00; 95% CI, 1.38-11.55), pregabalin (RR, 1.88; 95% CI, 1.13-3.14), and cinnarizine (RR, 1.46; 95% CI, 1.04-2.05) were associated with significantly greater effectiveness than placebo. Compared with placebo, propranolol and cinnarizine (RoM, 0.45; 95% CI, 0.28-0.72), pregabalin (RoM, 0.57; 95% CI, 0.33-0.96), valproate (RoM, 0.60; 95% CI, 0.49-0.72), levetiracetam (RoM, 0.62; 95% CI, 0.50-0.77), and cinnarizine (RoM, 0.64; 95% CI, 0.54-0.76) were significantly associated with reduction in headache intensity. However, no treatments were associated with significant improvements in quality of life or reduction of the duration of migraine attacks. Adverse events were higher with amitriptyline (RR, 3.81; 95% CI, 1.41-10.32), topiramate (RR, 4.34; 95% CI, 1.60-11.75), and valproate (RR, 5.93; 95% CI, 1.93-18.23) compared with placebo.Conclusions and RelevanceIn this network meta-analysis of randomized clinical trials, topiramate and pregabalin were associated with reduction in headache frequency and intensity. Although there were also other drugs that showed statistically significant results (flunarizine, riboflavin, amitriptyline, and cinnarizine), more studies were required for a robust conclusion. None of the drugs were associated with improved quality of life or attack duration, underscoring the need for further research to develop more comprehensive treatment strategies and explore the potential of combination therapies, especially those involving vitamins. Future studies should focus on validating these findings and expanding the treatment landscape for pediatric migraine management.

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Anxiety and Depressive Symptoms and Disorders in Children and Adolescents With Migraine

Cited by 26 publications

References 96 publications

American Headache Society 65^th Annual Scientific Meeting June 15‐18, 2023 Austin, Texas

American Headache Society 65^th Annual Scientific Meeting June 15‐18, 2023 Austin, Texas

Headache and Psychological Comorbidities: An Appraisal of the Evidence

Preventive Medications in Pediatric Migraine

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Anxiety and Depressive Symptoms and Disorders in Children and Adolescents With Migraine

Cited by 26 publications

References 96 publications

American Headache Society 65th Annual Scientific Meeting June 15‐18, 2023 Austin, Texas

American Headache Society 65th Annual Scientific Meeting June 15‐18, 2023 Austin, Texas

Headache and Psychological Comorbidities: An Appraisal of the Evidence

Preventive Medications in Pediatric Migraine

Contact Info

Product

Resources

About

American Headache Society 65^th Annual Scientific Meeting June 15‐18, 2023 Austin, Texas

American Headache Society 65^th Annual Scientific Meeting June 15‐18, 2023 Austin, Texas