Similarities and Differences Between Migraine in Children and Adults: Presentation, Disability, and Response to Treatment

Diest, Ashley M. Kroon Van; Ernst, Michelle M.; Slater, Shalonda; Powers, Scott W.

doi:10.1007/s11916-017-0648-2

Cited by 25 publications

(24 citation statements)

References 53 publications

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“…The shorter duration of migraine attacks and other semeiological features of migraines in children have made it difficult to design adequate randomized control trials. Also, children encounter difficulty in describing the features of headache and any associated symptoms [10,29]. Although the issues above are making it difficult to design proper randomized controlled trials, the significant improvement seen with our retrospective data and the prior onabotulinum studies in the pediatric population clearly demonstrate that the time is now for taking this next step and designing such trials.…”

Section: Discussionmentioning

confidence: 86%

“…Clinical observation is critical in younger children, and photophobia and photophobia may be inferred from their behavior [3]. Despite these few differences in presentation between the adult and pediatric populations, overall, the clinical presentation of migraine is similar, regardless of age, and the pathophysiology is thought to be similar [10].…”

Section: Introductionmentioning

confidence: 99%

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Further Evidence that Onabotulinum Toxin is a Viable Treatment Option for Pediatric Chronic Migraine Patients

Ali¹,

Bragin²,

Rende³

et al. 2019

Cureus

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Introduction Chronic migraine is particularly devastating. It affects school work, extracurricular activities, and quality of life, including relationships with other family members, and can also influence the mental health of both the migraineurs and family members. According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), chronic migraine is defined as 15 or more headache days per month for greater than three months, where at least on eight days per month, there are features of migraine headache. Although botulinum toxin type A (BoNTA) has been proven effective for treating chronic migraine in adults, little literature exists about its use in children. Here, we present the treatment response in children with chronic migraines treated with BoNTA at our institutions Duke and State University of New York (SUNY) Upstate. Method A retrospective analysis of 30 adolescent migraineurs who met ICHD-3 criteria for chronic migraine were treated with BoNTA injection according to the standardized adult protocol. Descriptive statistics and paired t-tests were performed. A total of 185 units of botulinum toxin were injected intramuscularly per patient, as in addition to the standard 31 sites for a total of 155 units, an additional 30 units were given in areas that were felt to provide further benefit. Results Participants (n=30) were 16.5 ± 1.83 years old. The headaches were precipitated by trauma in seven cases. All had failed standard pharmacotherapy, including amitriptyline and topiramate. An average of 2.47 ± 1.6 BoNTA injection cycles was performed. Migraine severity decreased significantly from 7.47 ± 1.89 on a 10-point scale to 4.34 ± 3.02 (p<.001). Additionally, headache frequency improved from 24.4 ± 7.49 painful days per month to 14.8 ± 12.52 painful days per month (p<.001). One patient developed nausea related to injections; all others tolerated it well, with no side effects. Discussion BoNTA injection was a safe and effective therapy for chronic migraine in our cohort of children recalcitrant to medical therapy. Further research with multi-centered, double-blinded, randomized, placebo-controlled trials is warranted to evaluate the long-term safety and efficacy in this population.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Further Evidence that Onabotulinum Toxin is a Viable Treatment Option for Pediatric Chronic Migraine Patients

Ali¹,

Bragin²,

Rende³

et al. 2019

Cureus

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“…Future research should characterize the psychological traits and cognitive biases that contribute to the stress sensitivity of CVS attacks. The role of lifestyle factors including stress management, consistent sleep routines, regularly scheduled meals, maintenance of hydration, regular exercise, and identification of episode triggers, factors that have been implemented in migraine prevention, may provide additional insight into CVS episode prevention . Understanding these relationships may provide a rational basis for using psychological or mind‐body interventions to influence the disease course in CVS.…”

Section: Pathophysiology and Comorbid Conditionsmentioning

confidence: 99%

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

Hasler

Levinthal

Tarbell

et al. 2019

Neurogastroenterology Motil

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Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS‐like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo‐controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS‐specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.

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“…At home, it impacts parents and caregivers which increases their stress, hurts relationships, and decreases family involvement in family activities. 46 Additionally, many patients with childhood chronic migraine go on to have chronic migraine as adults. 47 In adults, there are numerous medications available for acute and preventive treatment; however in children, there are far less.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Botulinum Toxin in Pediatric Chronic Migraine: A Literature Review

Marcelo

Freund

2020

J Child Neurol

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Aims: To conduct a review of the literature on the use of botulinum toxin for the treatment of pediatric chronic migraine. Methods: A review of the literature was performed using EMBASE, PubMed, and Cochrane/Ovid. Using our inclusion and exclusion criteria, we targeted any study, published before April 2020, evaluating the efficacy of botulinum toxin in migraineurs younger than 18 years. Results: Seven studies were included: 2 retrospective analyses, 3 case series, a case report, and a randomized control trial. Studies included 1 to 125 patients, with the number of botulinum toxin treatments ranging from 1 to 11 treatments. The results of the randomized controlled trial showed nonsuperiority between placebo and botulinum toxin. Results of the other studies were generally favorable but were difficult to compare because of lack of standardization of botulinum toxin dosing, injection paradigm, frequency and duration of treatment, usage of accompanying prophylaxis, and variation in outcome measures across studies. There was low-quality evidence that botulinum toxin improved headache frequency and intensity, though some studies demonstrated efficacy in treatment with botulinum toxin. Conclusion: This review is the first of its kind, updating the literature on the efficacy of botulinum toxin in pediatric patients. Given evidence of its utility in treating pediatric migraines, off-label use should be considered in certain cases. Further study is warranted to better characterize injection paradigms and patient selection because of the limited and inconsistent data available.

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Similarities and Differences Between Migraine in Children and Adults: Presentation, Disability, and Response to Treatment

Cited by 25 publications

References 53 publications

Further Evidence that Onabotulinum Toxin is a Viable Treatment Option for Pediatric Chronic Migraine Patients

Further Evidence that Onabotulinum Toxin is a Viable Treatment Option for Pediatric Chronic Migraine Patients

Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions

The Efficacy of Botulinum Toxin in Pediatric Chronic Migraine: A Literature Review

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