Headache in Individuals with Neurodevelopmental Disorders

Chadehumbe, Madeline

doi:10.1007/s11916-023-01153-y

Cited by 3 publications

(1 citation statement)

References 37 publications

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“…Indeed, um-PEA is a well-established supplementary food for long-term therapy in several clinical conditions [32,[65][66][67], having almost no known or potential adverse effects [25,30] and welldocumented safety and tolerability at doses of 300-1200 mg per day, with negligible acute and repeated dose toxicity [25,30]. Interestingly, PEA treatment has also been proven to provide relief to several other physical and neuropsychiatric unpleasant conditions which often affect the health status of autistic individuals (e.g., irritable bowel disease, dentary problems, headaches, and sleep problems) [32,66,[68][69][70][71][72][73]. Additionally, blood and stool samples will be obtained at each timepoint for analysis of the inflammatory response, metabolic profile, eCB system, and microbial composition.…”

Section: Discussionmentioning

confidence: 99%

The Supplementation Therapy in Autism and Response to Treatment (START) Study: An Open-Label Feasibility Trial of Ultramicronized Palmitoylethanolamide Potential to Alleviate Psychic Distress among Autistic Adults

Bortoletto,

Basaldella,

Candolo

et al. 2024

CTN

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Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by impaired social communication and restricted or repetitive behavior and interests. Psychic distress is common among individuals with ASD, especially in its milder form (level 1), with anxiety and depression being the most common types. Recent research has identified neuroinflammation and gut dysbiosis as potential neurobiological mechanisms underlying ASD. Palmitoylethanolamide (PEA), an endocannabinoid (eCB)-like compound, has shown promise in modulating such mechanisms and may thus have therapeutic implications for ASD. To date, no clinical trial has evaluated the efficacy of PEA in adults with ASD. This 12-week open-label study will assess the feasibility, tolerability, safety, and efficacy of ultramicronized PEA (um-PEA) in treating symptoms of psychic distress, such as anxiety and depression, in adults with level 1 ASD. Secondary research endpoints will include um-PEA’s effects on levels of personal autonomy and neurocognitive and interpersonal function. From a biological point of view, this study will assess um-PEA’s effects on inflammatory markers, the metabolic profile, eCB system modulation, and microbial composition as potential mechanisms of action for its therapeutic effect. In conclusion, this study will investigate a novel approach to the treatment of adults presenting with psychic distress in the context of level 1 ASD. The results may provide valuable insight into the use of um-PEA as a treatment option for ASD adults, addressing a significant unmet clinical need.

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Section: Discussionmentioning

confidence: 99%

The Supplementation Therapy in Autism and Response to Treatment (START) Study: An Open-Label Feasibility Trial of Ultramicronized Palmitoylethanolamide Potential to Alleviate Psychic Distress among Autistic Adults

Bortoletto,

Basaldella,

Candolo

et al. 2024

CTN

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Headaches and adolescents: why so many failures in their management

Cucchiaro,

Frye

2024

Eur J Pediatr

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The management of headaches in children and adolescents is still a challenge, with patients experiencing pain for years and polypharmacy. We reviewed the medical history of 31 patients referred to our pain clinic for chronic headaches between April 2023 and April 2024. There were more female than male patients (73%). Patients have been reporting headaches for 52 ± 44 months on average. Twenty-nine patients (94%) were experiencing different types of pain besides headaches. The most common medication prescribed in this group of patients was topiramate (70%), followed by tricyclic antidepressants (35%) and triptans (21%). Patients had been prescribed and tried, on average, 4.5 ± 2 (range 1–10) different medications to manage headaches and concomitant psychiatric disorders. Twenty-two patients (71%) had been diagnosed with a psychiatric disorder, including depression, anxiety, and PTSD, and 16% had a history of attempted suicide/self-harm. Fourteen of them (45%) had been prescribed antidepressants or benzodiazepines. They had been prescribed, on average, 2 ± 1 (range 1–4) psychiatric stabilizer medications. We agreed with the referral diagnosis in 39% of the patients. We attributed the headaches to more complex chronic pain conditions, including fibromyalgia (15%) and AMPS (15%), autism with sensory integration problems (9%), and major depression (9%). Patients had seen an average of 3 ± 1 (range 1–5) different specialists; none consulted a pain specialist. Patients underwent between 0 (12%) and four tests (6%), including MRI (52%) and CT of the brain (8%). These neuroimaging studies did not demonstrate any brain pathology. We prescribed new medications and treatments, including nerve blocks, in 19 (61%) patients. In 47% of the cases, patients reported improved headaches, while 22% did not feel our recommendations were effective. Twenty-one percent of patients never came back to the clinic for a follow-up. Significant catastrophizing was present in 57% of the patients; 52% of patients had mild to severe anxiety, and 57% had symptoms of depressive disorder. Conclusions : Headaches are often the manifestation of more complex pain syndromes that require a more holistic approach, different from conventional pharmacological management. What is Known: • Headache is one of the most disabling diseases. • Prevalence of headaches in hildrens and adolescents can be as high as 58%. What is New: • Conventional pharmacological management often fails to help young patients. • A relationship between chronic headaches and psychopathology should be investigated in these young patients.

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Investigating pain-related medication use and contribution to polypharmacy in adults with intellectual disabilities: a systematic review

Pacitti,

Cairns,

Ward

et al. 2024

BMC Med

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Background Adults with intellectual disability experience more pain than adults without and, despite a higher number of medications being prescribed, may be less likely to receive medication for pain. We conducted a systematic review of existing literature on medication for pain and painful conditions in adults with intellectual disability to explore if there is any association with polypharmacy, multimorbidity or demographic characteristics. Methods This systematic review followed PRISMA guidelines. Medline, Embase, PubMed, PsycINFO, Web of Science, CINAHL, Cochrane Library and Scopus were searched from January 2000 to 21st October 2024. We included original, peer-reviewed observational, qualitative or mixed-method studies published in English with data on medication for pain or painful conditions in adults with intellectual disability. Two independent reviewers performed study selection, data extraction, and quality assessment; disagreements were resolved by a third reviewer. Adapted Newcastle–Ottawa Scale or the Critical Appraisal Skills Programme for qualitative studies was used for quality assessment of included studies and findings were reported via narrative synthesis. PROSPERO registration: CRD42023415051. Results Twenty-seven of 26,170 articles met the eligibility criteria. Adults with intellectual disability were more likely to have simple analgesic medication than non-steroidal anti-inflammatory drugs, opioids or adjuvant pain medications than the general population. Psychotropic medications were more commonly prescribed in adults with intellectual disability than medication for pain or painful conditions. Adults with intellectual disability and caregivers reported under-recognition and most likely under-treatment of pain. Conclusions Adults with intellectual disability may receive less pharmacological management of pain with analgesics and medication for painful conditions despite the high prevalence of polypharmacy, suggesting pain is under-treated. Better assessment and pharmacological treatment of pain and painful conditions is a key future research priority to address this health inequality and improve quality of life for this vulnerable group of people.

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Headache in Individuals with Neurodevelopmental Disorders

Cited by 3 publications

References 37 publications

The Supplementation Therapy in Autism and Response to Treatment (START) Study: An Open-Label Feasibility Trial of Ultramicronized Palmitoylethanolamide Potential to Alleviate Psychic Distress among Autistic Adults

The Supplementation Therapy in Autism and Response to Treatment (START) Study: An Open-Label Feasibility Trial of Ultramicronized Palmitoylethanolamide Potential to Alleviate Psychic Distress among Autistic Adults

Headaches and adolescents: why so many failures in their management

Investigating pain-related medication use and contribution to polypharmacy in adults with intellectual disabilities: a systematic review

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