Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade?

Papetti, Laura; Ursitti, Fabiana; Moavero, Romina; Ferilli, Michela Ada Noris; Sforza, Giorgia; Tarantino, Samuela; Vigevano, Federico; Valeriani, Massimiliano

doi:10.3389/fneur.2019.00771

Cited by 40 publications

(39 citation statements)

References 56 publications

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“…Furthermore, the high response to placebo raises doubt about the actual need to treat migraine children with drugs that may have adverse effects [20]. is is why the choice falls very often on nutraceuticals whose efficacy data however remain conflicting [8].…”

Section: Discussionmentioning

confidence: 99%

“…Although amitriptyline, topiramate, and flunarizine have the most solid data supporting their use for migraine prophylaxis in children, a serious lack of controlled studies on the pharmacological treatment still remains [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…In absence of consistent, high-quality efficacy data for the use of pharmacologic preventive migraine interventions targeted at children and adolescents, another modality worth to be explored consists in the use of nonpharmacologic pillbased interventions including nutraceuticals. Nutraceuticals may be offered to parents who are reluctant to start their child on a daily medication [8].…”

Section: Introductionmentioning

confidence: 99%

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Tolerability of Palmitoylethanolamide in a Pediatric Population Suffering from Migraine: A Pilot Study

Papetti

Sforza

Tullo

et al. 2020

Pain Research and Management

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Background. Palmitoylethanolamide (PEA) is emerging as a new therapeutic approach in pain and inflammatory conditions, and it has been evaluated in studies on various painful diseases. The aim of this open-label study was to evaluate the efficacy of ultramicronized PEA (umPEA) in the prophylactic treatment of migraine. Methods. The study included 70 patients with mean age of 10.3 ± 2.7 (24.5% M and 75.5% F). All patients had a diagnosis of migraine without aura (ICHD 3 criteria) and received umPEA (600 mg/day orally) for three months. We compared the attack frequency (AF) and attack intensity at baseline and after three months. Patients were asked to classify the intensity of the attack with a value ranging from 1 to 3, where 1 means mild attack, 2 moderate, and 3 severe attack. Results. Nine patients discontinued treatment before the target time of 12 weeks. After 3 months of treatment with umPEA, the headache frequency was reduced by >50% per month in 63.9% patients. The number of monthly attacks at T1 decreased significantly compared with the baseline assessment (from 13.9 ± 7.5 SD of T0 to 6.5 ± 5.9 SD of T1; p<0.001). The mean intensity of the attacks dropped from 1.67 ± 0.6 (T0) to 1.16 ± 0.5 (T1) (p<0.001), and the percentage of patients with severe attacks decreased after treatment (from 8.2% to 1.6%; p<0.05). The monthly assumptions of drugs for the attack reduced from 9.5 ± 4.4 to 4.9 ± 2.5 (p<0.001). Only one patient developed mild side effects (nausea and floating). Conclusions. Our preliminary data show that umPEA administered for three month reduces pain intensity and the number of attacks per month in pediatric patients with migraine. Although the small number of patients and the lack of control group do not allow us to consider these initial results as definitely reliable, they encourage us to expand the sample.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Tolerability of Palmitoylethanolamide in a Pediatric Population Suffering from Migraine: A Pilot Study

Papetti

Sforza

Tullo

et al. 2020

Pain Research and Management

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“…Interestingly, our results may have clinical implications for the management and treatment of pediatric migraine. Children and adolescents with recurrent headaches may require prophylactic therapy, which is usually prolonged for some months (Papetti et al, 2019). Most drugs currently used for migraine prophylaxis, such as amitriptyline and flunarizine, can lead to body weight increase (Young and Rozen, 2005;Silberstein, 2015).…”

Section: Discussionmentioning

confidence: 99%

Anxiety, Depression, and Body Weight in Children and Adolescents With Migraine

et al. 2020

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Background: There is a lack of studies that explore the possible association between body weight, psychological symptoms, and migraine severity in pediatric populations. The purpose of the study was to explore: (1) the association between body weight and the frequency of migraine attacks, (2) the possible differences in anxiety and depression symptoms according to the frequency of attacks and body weight, and (3) the possible mediating role of anxiety and/or depression in the association between body weight and frequency of migraine attacks in children. Methods: One hundred and eleven children/adolescents with migraine were included (47 boys and 64 girls; mean age 11.7; ±2.4 years). The patients were classified as: (1) high frequency patients, reporting from weekly to daily episodes and (2) low frequency patients, with ≤3 episodes per month. According to their body mass index percentiles, the patients were divided in "Normal weight" (from ≥5 to <85 percentile), "Overweight" (from ≥85 to <95 percentile), and "Obese" (≥95 percentile). Given the low number of obese patients, the overweight and obese groups were considered together in the "Overweight" group. Anxiety and depression symptoms were assessed by the Self-Administered Psychiatric Scales for Children and Adolescents (SAFA). Results: Fifty-four patients were normal in weight (49.6%), while 56 patients (50.4%) were overweight. The overweight patients showed a higher frequency of migraine attacks (64.7%; p < 0.05). Patients with a high frequency of attacks reported higher scores in all SAFA-Anxiety subscales (SAFA-A Tot: F = 15.107; p = 0.000). Overweight patients showed a significantly higher score in the "Separation anxiety" subscale (F = 7.855; p = 0.006). We found a mediating role between the overweight and high frequency for total anxiety (z = 2.11 ± 0.03; p < 0.05) and social anxiety (z = 2.04 ± 0.03; p < 0.05). Conclusions: Our results suggest that, among the children suffering from migraine, the overweight status is associated with a higher frequency of attacks and separation anxiety symptoms. In particular, our study provides the first evidence of the role of anxiety in linking overweight and the frequency of migraine attacks in children and adolescents.

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“…Furthermore, it should be noted, that the effect of placebo is possibly larger for children than adults (38), and thus larger effects are needed to demonstrate differences between treatment and sham interventions.…”

Section: Previous Literaturementioning

confidence: 99%

Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7-14 years. A randomised clinical trial

Lynge¹,

Dissing²,

Vach³

et al. 2020

Preprint

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Background To investigate the effectiveness of chiropractic spinal manipulation versus sham manipulation in children aged 7-14 with recurrent headaches.Methods Design: A two-arm, single-blind, superiority randomised controlled trial.Setting: One chiropractic clinic and one paediatric specialty practice in Denmark Participants: 199 children aged 7 to 14 years, who experienced at least one episode of headache per week for the previous 6 months and with at least one musculoskeletal dysfunction identified. Interventions: All participants and parents received standard oral and written advice to reduce headaches. In addition, children in the active treatment group received chiropractic spinal manipulation and children in the control group received sham manipulation for a period of 4 months. Number and frequency of treatments were based on the chiropractor’s individual evaluation in the active treatment group, and the children in the control group received approximately eight visits during the treatment period.Primary outcome measures: ‘Number of days with headache’, ‘pain intensity’ and ‘medication’ were reported weekly by text messages, and global perceived effect by text message after 4 months. A planned fixed sequence strategy based on an initial outcome data analysis was used to prioritize outcomes. ‘Number of days with headache’ and ‘pain intensity’ were chosen as equally important outcomes of highest priority, followed by global perceived effect and medication. The significance level for the first two outcomes was fixed to 0.025 to take multiplicity into account.Results Chiropractic spinal manipulation resulted in significantly fewer days with headaches (reduction of 0.81 vs. 0.41, p=0.019, NNT=7 for 20% improvement) and better global perceived effect (dichotomized into improved/not improved, OR=2.8 (95% CI: 1.5-5.3), NNT=5) compared with a sham manipulation procedure. There was no difference between groups for pain intensity during headache episodes. Due to methodological shortcomings, no conclusions could be drawn about medication use.Conclusions Chiropractic spinal manipulation resulted in fewer headaches and higher global perceived effect, with only minor side effects. It did not lower the intensity of the headaches.Since the treatment is easily applicable, of low cost and minor side effects, chiropractic spinal manipulation might be considered as a valuable treatment option for children with recurrent headaches.Trial registration ClinicalTrials.gov, identifier NCT02684916, registered 02/18/2016 – retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02684916

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Prophylactic Treatment of Pediatric Migraine: Is There Anything New in the Last Decade?

Cited by 40 publications

References 56 publications

Tolerability of Palmitoylethanolamide in a Pediatric Population Suffering from Migraine: A Pilot Study

Tolerability of Palmitoylethanolamide in a Pediatric Population Suffering from Migraine: A Pilot Study

Anxiety, Depression, and Body Weight in Children and Adolescents With Migraine

Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7-14 years. A randomised clinical trial

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