Dados do Trabalho

Título

THE RESPONSE OF PROPHYLACTIC PHARMACOLOGICAL TREATMENT OF MIGRAINE IN CHILDREN AND ADOLESCENTS

Introdução

Migraine is a prevalent condition in childhood and adolescence, significantly impacting patients' quality of life. Prophylactic pharmacological treatment can be crucial in reducing the frequency and severity of attacks. This descriptive study aims to analyze the response to prophylactic treatment in a pediatric cohort with migraine.

Objetivo

This study aims to describe the response to various prophylactic treatments used for migraine in children and adolescents. The motivation is to understand the relative efficacy of different medications and the need for therapeutic adjustments based on real clinical observations.

Método

The study included 46 patients aged 3 to 18 years, with a mean age of 14 years; 13 of these were boys. Among the patients, 15/46 (32%) did not require prophylactic treatment, experiencing improvement through behavioral changes and lifestyle modifications alone. The remaining 31/46 (68%) required prophylactic treatment to reduce the frequency or intensity of their attacks. The most commonly used medication was flunarizine, prescribed to 8 patients, followed by propranolol in 6 patients, nortriptyline in 4 patients, and topiramate in 4 patients. Of the patients receiving prophylaxis, 14 had previously used a prophylactic treatment, most frequently topiramate and flunarizine, which were discontinued due to inadequate response. Additionally, 6 patients received botulinum toxin treatment. Overall, the medications were well tolerated, with few side effects reported.

Resultados

The data indicated that a small proportion of patients (15/46) improved with only behavioral and lifestyle changes, while the majority required prophylactic treatment. Botulinum toxin was associated with the most significant reduction in the frequency and severity of attacks

Conclusão

This study described a cohort of patients in a tertiary care setting with migraine treatment, demonstrating safety and effectiveness. Botulinum toxin was found to be the most effective option for reducing the frequency and severity of migraine attacks in children and adolescents compared to other prophylactic medications like flunarizine and propranolol. These findings suggest that botulinum toxin may be the most effective treatment for many patients, although the choice of treatment should be individualized based on patient needs and characteristics. Overall, the medications were well tolerated, with minimal side effects.

Referências

Szperka CL, VanderPluym JH, Oakley CB. Pharmacologic Acute and Preventive Treatment for Migraine in Children and Adolescents. JAMA Neurol. 2020;77(3):388–389. doi:10.1001/jamaneurol.2019.4170
Abu-Arafeh I, Morozova M. Migraine in children and adolescents: Assessment and diagnosis. Handb Clin Neurol. 2024;199:475-485. doi: 10.1016/B978-0-12-823357-3.00029-X. PMID: 38307664.
Szperka C. Headache in Children and Adolescents. Continuum (Minneap Minn). 2021 Jun 01;27(3):703-731.
O'Brien HL, Kabbouche MA, Kacperski J, Hershey AD. Treatment of pediatric migraine. Curr Treat Options Neurol. 2015 Jan;17(1):326.
Rothner AD. Migraine Variants in Children. Pediatr Ann. 2018 Feb 01;47(2):e50-e54.
Greene K, Irwin SL, Gelfand AA. Pediatric Migraine: An Update. Neurol Clin. 2019 Nov;37(4):815-833.

Palavras Chave

Migraine; Prophylactic Treatment; botulinum toxin