Irene Toldo1, Martina Rattin2, Egle Perissinotto3, Debora De Carlo4, Barbara Bolzonella5, Margherita Nosadini6, Livia Nicoletta Rossi7, Angelo Vecchio8, Alessandro Simonati9, Marco Carotenuto10, Cinzia Scalas11, Vittorio Sciruicchio12, Vincenzo Raieli13, Giovanni Mazzotta14, Elisabetta Tozzi15, Massimiliano Valeriani16, Carlo Cianchetti17, Umberto Balottin18, Vincenzo Guidetti19, Stefano Sartori20, Pier Antonio Battistella21. 1. Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: irene.toldo@unipd.it. 2. Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: martina.rattin@libero.it. 3. Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy. Electronic address: egle.perissinotto@unipd.it. 4. Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: debora.decarlo@hotmail.it. 5. Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: dottbarbara@yahoo.it. 6. Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: margherita.nosadini@gmail.com. 7. Second Paediatric Department, University of Milan, Italy. Electronic address: livia.rossi@unimi.it. 8. Child Neuropsychiatry Division, University of Palermo, Italy. Electronic address: cefalee.neuroriabilitazione@ausl6palermo.org. 9. Department of Neurological Sciences, University of Verona, Italy. Electronic address: alessandro.simonati@univr.it. 10. Juvenile Headache Centre, Second University of Naples, Italy. Electronic address: marco.carotenuto@unina2.it. 11. Juvenile Headache Centre, University Hospital of Florence, Italy. Electronic address: centrocefalee@meyer.it. 12. Paediatric Neurology, ''Giovanni XXIII'' Hospital Policlinico of Bari, Italy. Electronic address: vsciru@tin.it. 13. Child Neuropsychiatry Division, "G.F. Ingrassia" Hospital, AUSL n°6, Palermo, Italy. Electronic address: vinzi.raielk@inwind.it. 14. Child and Juvenile Neuropsychiatry Unit, ASL n°4, Terni, University of Perugia, Italy. Electronic address: giovanni.mazzotta@unipg.it. 15. Department of Experimental Medicine, University of L'Aquila, Italy. Electronic address: elisabetta.tozzialleva@univaq.it. 16. Headache Centre, Division of Neurology, Children's Hospital Bambino Gesú, Rome, Italy. Electronic address: valeriani@opbg.net. 17. Child and Adolescent Neuropsychiatry, University Hospital of Cagliari, Italy. Electronic address: cianchet@unica.it. 18. Child Neuropsychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy. Electronic address: umberto.balottin@unipv.it. 19. Department of Pediatrics and Child and Adolescent Neuropsychiatry, University "La Sapienza" of Rome, Italy. Electronic address: vincenzo.guidetti@uniroma1.it. 20. Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: stefano.sartori@unipd.it. 21. Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: pierantonio.battistella@unipd.it.
Abstract
AIM: The purpose of this retrospective multicenter study was to evaluate the use and the self-perceived efficacy and tolerability of pharmacological and non-pharmacological treatments in children and adolescents with primary headaches. METHODS: Study of a cohort of children and adolescents diagnosed with primary headache, consecutively referred to 13 juvenile Italian Headache Centers. An ad hoc questionnaire was used for clinical data collection. RESULTS: Among 706 patients with primary headaches included in the study, 637 cases with a single type of headache (migraine 76% - with and without aura in 10% and 67% respectively; tension-type headache 24%) were selected (mean age at clinical interview: 12 years). Acetaminophen and non-steroidal anti-inflammatory drugs (in particular ibuprofen) were commonly used to treat attacks, by 76% and 46% of cases respectively. Triptans were used overall by 6% of migraineurs and by 13% of adolescents with migraine, with better efficacy than acetaminophen and non-steroidal anti-inflammatory drugs. Preventive drugs were used by 19% of migraineurs and by 3% of subjects with tension-type headache. In migraineurs, flunarizine was the most frequently used drug (18%), followed by antiepileptic drugs (7%) and pizotifen (6%), while cyproheptadine, propanolol and amitriptyline were rarely used. Pizotifen showed the best perceived efficacy and tolerability. Melatonin and nutraceuticals were used by 10% and 32% of subjects, respectively, both for migraine and tension-type headache, with good results in terms of perceived efficacy and tolerability. Non-pharmacological preventive treatments (i.e. relaxation techniques, biofeedback, cognitive-behavioral therapy, acupuncture) were used only by 10% of cases (migraine 9%, tension-type headache 15%). DISCUSSION: Non-steroidal anti-inflammatory drugs, especially ibuprofen, should be preferred to acetaminophen for acute attacks of migraine or tension-type headache, because they were usually more effective and well tolerated. Triptans could be used more frequently as first or almost second choice for treating migraine attack in adolescents. Non-pharmacological preventive treatments are recommended by some pediatric guidelines as first-line interventions for primary headaches and their use should be implemented in clinical practice. Prospective multicenter studies based on larger series are warranted to better understand the best treatment strategies for young people with primary headaches.
AIM: The purpose of this retrospective multicenter study was to evaluate the use and the self-perceived efficacy and tolerability of pharmacological and non-pharmacological treatments in children and adolescents with primary headaches. METHODS: Study of a cohort of children and adolescents diagnosed with primary headache, consecutively referred to 13 juvenile Italian Headache Centers. An ad hoc questionnaire was used for clinical data collection. RESULTS: Among 706 patients with primary headaches included in the study, 637 cases with a single type of headache (migraine 76% - with and without aura in 10% and 67% respectively; tension-type headache 24%) were selected (mean age at clinical interview: 12 years). Acetaminophen and non-steroidal anti-inflammatory drugs (in particular ibuprofen) were commonly used to treat attacks, by 76% and 46% of cases respectively. Triptans were used overall by 6% of migraineurs and by 13% of adolescents with migraine, with better efficacy than acetaminophen and non-steroidal anti-inflammatory drugs. Preventive drugs were used by 19% of migraineurs and by 3% of subjects with tension-type headache. In migraineurs, flunarizine was the most frequently used drug (18%), followed by antiepileptic drugs (7%) and pizotifen (6%), while cyproheptadine, propanolol and amitriptyline were rarely used. Pizotifen showed the best perceived efficacy and tolerability. Melatonin and nutraceuticals were used by 10% and 32% of subjects, respectively, both for migraine and tension-type headache, with good results in terms of perceived efficacy and tolerability. Non-pharmacological preventive treatments (i.e. relaxation techniques, biofeedback, cognitive-behavioral therapy, acupuncture) were used only by 10% of cases (migraine 9%, tension-type headache 15%). DISCUSSION: Non-steroidal anti-inflammatory drugs, especially ibuprofen, should be preferred to acetaminophen for acute attacks of migraine or tension-type headache, because they were usually more effective and well tolerated. Triptans could be used more frequently as first or almost second choice for treating migraine attack in adolescents. Non-pharmacological preventive treatments are recommended by some pediatric guidelines as first-line interventions for primary headaches and their use should be implemented in clinical practice. Prospective multicenter studies based on larger series are warranted to better understand the best treatment strategies for young people with primary headaches.
Authors: Thomas Foiadelli; Alessandra Piccorossi; Lucia Sacchi; Mara De Amici; Maurizio Tucci; Ilaria Brambilla; Gian Luigi Marseglia; Salvatore Savasta; Alberto Verrotti Journal: Ital J Pediatr Date: 2018-04-04 Impact factor: 2.638
Authors: M C Jong; I Boers; H A van Wietmarschen; E Tromp; J O Busari; R Wennekes; I Snoeck; J Bekhof; A M Vlieger Journal: Eur J Pediatr Date: 2018-10-24 Impact factor: 3.183