Reconsideration of the diagnosis and treatment of childhood migraine: A practical review of clinical experiences

Saito, Yoshiaki; Yamanaka, Gaku; Shimomura, Hideki; Shiraishi, Kazuhiro; Nakazawa, Tomoyuki; Kato, Fumihide; Shimizu‐Motohashi, Yuko; Sasaki, Masayuki; Maegaki, Yoshihiro

doi:10.1016/j.braindev.2016.11.011

Cited by 5 publications

(6 citation statements)

References 24 publications

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“…There are fewer than expected clinicians who are making accurate diagnoses including specialists and misdiagnosis is common [ 44 ]. The overuse of diagnostics tests, unwarranted neuroimaging, and ambiguity about therapeutics are reported [ 45 , 46 ]. Given the strong and growing evidence of these associations, the children and adolescents diagnosed with migraine may benefit from additional assessment of the burden and psychosocial impairment related to psychiatric comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Off-Label Cyproheptadine in Children and Adolescents: Psychiatric Comorbidities, Interacting Variables, Safety, and Risks of Hepatotoxicity

Gupta¹,

Gupta²,

Madabushi³

2023

Cureus

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Cyproheptadine is a widely prescribed first-generation antihistamine, and due to its unique chemical structure, it has a popular off-label choice for a range of clinical conditions. Its efficacy is widely debated in the literature, but there are reports of hepatotoxicity as a rare adverse effect. Its benefits in migraine prophylaxis and appetite stimulation also underscore a highly overlapping clinical pathway that requires additional assessment and evaluation. The evidence suggests a baseline metabolic profile before initiation and assessment for co-occurring mental health conditions may improve overall response with evidencebased mental health interventions.

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Section: Discussionmentioning

confidence: 99%

Off-Label Cyproheptadine in Children and Adolescents: Psychiatric Comorbidities, Interacting Variables, Safety, and Risks of Hepatotoxicity

Gupta¹,

Gupta²,

Madabushi³

2023

Cureus

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“…For headache prevention, cyproheptadine, amitriptyline, propranolol, and antiepileptic drugs are often used. 17,19,21 Amitriptyline, topiramate, sodium valproate, levetiracetam, propranolol, lomerizine, and cyproheptadine are listed as pediatric migraine prophylactics in the Japanese clinical practice guidelines for headache treatment. 22 In the present study, some patients received a Chinese herbal remedy, the efficacy of which is also described in the previously mentioned guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…For acute treatment, acetaminophen and ibuprofen were often used in the present study, as recommended in previous reports. [17][18][19] Acetaminophen and ibuprofen were reportedly effective in 51-54% and 68-77% of children with migraine, respectively. [17][18][19][20] In the present study, acetaminophen showed the same efficacy as in previous reports, but ibuprofen was less effective.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19] Acetaminophen and ibuprofen were reportedly effective in 51-54% and 68-77% of children with migraine, respectively. [17][18][19][20] In the present study, acetaminophen showed the same efficacy as in previous reports, but ibuprofen was less effective. Because ibuprofen was mostly administered in cases in which acetaminophen was not effective, we considered it to be less effective.…”

Section: Discussionmentioning

confidence: 99%

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Classification of pediatric headache cases referred to a neurology department

Kanamori

Miyama

2022

Pediatrics International

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Background Headaches are very common in children. The patients often have mild symptoms, but on occasion may have severe, secondary headaches. The present study aimed to clarify the details of children with headaches seen at the outpatient clinic of a pediatric neurological department. Methods The present, retrospective observational study was conducted at a tertiary pediatric hospital in Japan and enrolled children referred to the neurology department outpatient clinic for headache between April 2018 and March 2021. Results In total, 113 cases of headache were examined; of these, 99 (87.6%) were primary headaches, one case (0.9%) was a secondary headache, and 13 (11.5%) were unclassified or unspecified. There were 46 cases (40.7%) of tension‐type headache (TTH), both confirmed and suspected, 30 cases (26.5%) of migraine, and 23 cases (20.4%) of a combination of the TTH and migraine. One case of secondary headache was attributed to an infection. Arachnoid cysts were found in seven patients (7.8%). Acute drug treatments were administered to 93 patients (82.3%), with acetaminophen being the most common drug, followed by ibuprofen. Prophylactic drug treatments were administered to 39 patients (34.5%), with goreisan (a Chinese herbal medicine containing Alisma orientale, Poria cocos, Polyporus umbellatus, Atractylodes lancea, and Cinnamomum cassia) being the most common (41%). Conclusions Few cases of secondary headache and none of emergency headache were diagnosed. The prevalence of arachnoid cysts was higher than in the general pediatric population, suggesting that arachnoid cysts might be associated with headache.

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“…Of the non-school-attending students in Japan, 30–40% reportedly had orthostatic dysregulation (OD) [ 2 ]. OD is characterized by autonomic nervous system dysfunction, involving various symptoms, such as dizziness and difficulty getting out of bed [ 2 , 3 , 4 , 5 , 6 , 7 ]. Due to these symptoms, OD is known to cause wake-up difficulty, including the difficulties in waking up and getting out of bed despite being awake.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a Combination Therapy for Difficulties Waking Up in Non-School-Attending Students

Konishi

Kumagai

Sawatari

et al. 2022

JCM

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School non-attendance due to difficulties waking up is increasing in Japan, and affected students are commonly diagnosed with orthostatic dysregulation (OD); however, OD-associated sleep problems are overlooked. To date, no sleep-medicine-based treatment for wake-up difficulties in non-school-attending students has been established. This study aimed to assess the efficacy of a novel combination therapy for these students. We assessed the combined effect of sleep hygiene guidance, low-dose aripiprazole administration (3 mg/day), and blue-light exposure on wake-up difficulty in 21 non-school-attending teenage patients. The patients were evaluated using sleep studies and questionnaires before and after treatment. The average subjective total sleep time calculated from sleep diaries before treatment in the patients was 10.3 h. The therapy improved wake-up difficulty by 85.7% and further improved school non-attendance by 66.7%. The subjective sleep time significantly decreased by 9.5 h after treatment (p = 0.0004). The self-rating Depression Scale and mental component summary of the 36-item Short-Form Health Survey significantly improved after treatment (p = 0.002 and p = 0.01, respectively). Wake-up difficulties were caused by the addition of a delayed sleep phase to the patients’ long sleep times. The novel combination therapy was effective in improving wake-up difficulty and mental quality of life in non-school-attending teenage students.

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Reconsideration of the diagnosis and treatment of childhood migraine: A practical review of clinical experiences

Cited by 5 publications

References 24 publications

Off-Label Cyproheptadine in Children and Adolescents: Psychiatric Comorbidities, Interacting Variables, Safety, and Risks of Hepatotoxicity

Off-Label Cyproheptadine in Children and Adolescents: Psychiatric Comorbidities, Interacting Variables, Safety, and Risks of Hepatotoxicity

Classification of pediatric headache cases referred to a neurology department

Efficacy of a Combination Therapy for Difficulties Waking Up in Non-School-Attending Students

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