Abstract
Purpose of Review
This review presents findings from investigations of migraine in children and adults. Similarities and differences in the presentation, related consequences, and treatments between children and adults are reviewed.
Recent Findings
Significant similarities exist in the presentation, disability, and treatments for migraine between children and adults. Despite such similarities, many adult migraine treatments adapted for use in children are not rigorously tested prior to becoming a part of routine care in youth. Existing research suggests that not all approaches are equally effective across age groups. Specifically, psychological treatments are shown to be somewhat less effective in adults than in children. Pharmacological interventions found to be statistically significant relative to placebo in adults may not be as effective in children and have the potential to present more risk than benefit when used in youth. The placebo effect in both children and adults is robust and is need of further study. Better understanding of treatment mechanisms for all interventions across the age spectrum is needed.
Summary
Although migraine treatments determined to be effective for adults are frequently adapted for use in children with little evaluation prior to implementation, existing research suggests that this approach may not be the best practice. Adaptation of adult pharmacological treatment for use in youth may present a particular risk in comparison to benefits gained. Because of the known efficacy of psychological treatments, such as cognitive behavioral therapy, more universal use of these interventions should be considered, either as first-line treatment or in combination with pill-based therapies.
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References
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Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343–9.
Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290(18):2443–54.
Hershey AD, Powers SW, Winner P, Kabbouche M. Pediatric headaches in clinical practice. West Sussex: UK John Wiley & Sons, Ltd.; 2009.
Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA. 1992;267(1):64–9.
Split W, Neuman W. Epidemiology of migraine among students from randomly selected secondary schools in Lodz. Headache. 1999;39(7):494–501.
Headache Classification C, Olesen J, Bousser MG, Diener HC, Dodick D, First M, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26(6):742–6.
Goadsby PJ, Lipton RB, Ferrari MD. Migraine—current understanding and treatment. N Engl J Med. 2002;346(4):257–70.
Steiner TJ, Stovner LJ, Birbeck GL. Migraine: the seventh disabler. J Headache Pain. 2013;14:1.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96.
Gorodzinsky AY, Hainsworth KR, Weisman SJ. School functioning and chronic pain: a review of methods and measures. J Pediatr Psychol. 2011;36(9):991–1002.
• Buse DC, Manack AN, Fanning KM, Serrano D, Reed ML, Turkel CC, et al. Chronic migraine prevalence, disability, and sociodemographic factors: results from the American Migraine Prevalence and Prevention Study. Headache. 2012;52(10):1456–70. Review of chronic migraine prevalence, costs, and disability.
• Sekhar M, Sonal EA. Migraine management: how do the adult and paediatric migraines differ? Saudi Pharmaceutical Journal. 2012;20(1):1–7. Review of differences in adult and pediatric migraine.
•• Holroyd KA, Drew JB. Behavioral approaches to the treatment of migraine. Semin Neurol. 2006;26(2):199–207. Review of effectiveness of CBT and medication for adult migraine.
Buse DC, Scher AI, Dodick DW, Reed ML, Fanning KM, Manack Adams A, et al. Impact of migraine on the family: perspectives of people with migraine and their spouse/domestic partner in the CaMEO study. Mayo Clin Proc. 2016;91(5):596–611.
Smith R. Impact of migraine on the family. Headache. 1998;38(6):423–6.
Eccleston C, Crombez G, Scotford A, Clinch J, Connell H. Adolescent chronic pain: patterns and predictors of emotional distress in adolescents with chronic pain and their parents. Pain. 2004;108(3):221–9.
Lipton RB, Bigal ME, Kolodner K, Stewart WF, Liberman JN, Steiner TJ. The family impact of migraine: population-based studies in the USA and UK. Cephalalgia. 2003;23(6):429–40.
Holmes AM, Deb P. The effect of chronic illness on the psychological health of family members. J Ment Health Policy Econ. 2003;6(1):13–22.
Lieberman MA, Fisher L. The impact of chronic illness on the health and well-being of family members. Gerontologist. 1995;35(1):94–102.
Palermo TM, Valrie CR, Karlson CW. Family and parent influences on pediatric chronic pain: a developmental perspective. Am Psychol. 2014;69(2):142–52.
Lewandowski AS, Palermo TM, Stinson J, Handley S, Chambers CT. Systematic review of family functioning in families of children and adolescents with chronic pain. J Pain. 2010;11(11):1027–38.
Campo JV, Bridge J, Lucas A, Savorelli S, Walker L, Di Lorenzo C, et al. Physical and emotional health of mothers of youth with functional abdominal pain. Arch Pediatr Adolesc Med. 2007;161(2):131–7.
Daniels D, Moos RH, Billings AG, Miller JJ III. Psychosocial risk and resistance factors among children with chronic illness, healthy siblings, and healthy controls. J Abnorm Child Psychol. 1987;15(2):295–308.
•• Powers SW, Coffey CS, Chamberlin LA, Ecklund DJ, Klingner EA, Yankey JW, Korbee LL, Porter LL, Hershey AD, CHAMP Investigators. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. N Engl J Med. 2017;376(2):115–124. Results from the CHAMP study that indicate preventative medications may present more risk than benefit in children.
Food and Drug Administration. Guidance for industry migraine: developing drugs for acute treatment. 2014. https://www.fda.gov/downloads/drugs/guidances/ucm419465.pdf
• Hershey AD. Current approaches to the diagnosis and management of paediatric migraine. Lancet Neurol. 2010;9(2):190–204. Review of presentation and treatment of pediatric migraine.
Linder SL, Mathew NT, Cady RK, Finlayson G, Ishkanian G, Lewis DW. Efficacy and tolerability of almotriptan in adolescents: a randomized, double-blind, placebo-controlled trial. Headache. 2008;48(9):1326–36.
Ahonen K, Hamalainen ML, Eerola M, Hoppu K. A randomized trial of rizatriptan in migraine attacks in children. Neurology. 2006;67(7):1135–40.
Brandes JL, Kudrow D, Stark SR, O'Carroll CP, Adelman JU, O'Donnell FJ, et al. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. 2007;297(13):1443–54.
Smith TR, Sunshine A, Stark SR, Littlefield DE, Spruill SE, Alexander WJ. Sumatriptan and naproxen sodium for the acute treatment of migraine. Headache. 2005;45(8):983–91.
Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, Lipton RB, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50(6):921–36.
Sun H, Dodick DW, Silberstein S, Goadsby PJ, Reuter U, Ashina M, et al. Safety and efficacy of AMG 334 for prevention of episodic migraine: a randomised, double-blind, placebo-controlled, phase 2 trial. Lancet Neurol. 2016;15(4):382–90.
Dodick DW, Turkel CC, DeGryse RE, Diener HC, Lipton RB, Aurora SK, et al. Assessing clinically meaningful treatment effects in controlled trials: chronic migraine as an example. J Pain. 2015;16(2):164–75.
Hershey AD, Powers SW, Bentti AL, Degrauw TJ. Effectiveness of amitriptyline in the prophylactic management of childhood headaches. Headache. 2000;40(7):539–49.
Ludvigsson J. Propranolol used in prophylaxis of migraine in children. Acta Neurol Scand. 1974;50(1):109–15.
Levinstein B. A comparative study of cyproheptadine, amitriptyline, and propranolol in the treatment of adolescent migraine. Cephalalgia. 1991;11:122–3.
Winner P, Pearlman EM, Linder SL, Jordan DM, Fisher AC, Hulihan J. Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. Headache. 2005;45(10):1304–12.
Apostol G, Cady RK, Laforet GA, Robieson WZ, Olson E, Abi-Saab WM, et al. Divalproex extended-release in adolescent migraine prophylaxis: results of a randomized, double-blind, placebo-controlled study. Headache. 2008;48(7):1012–25.
Powers SW, Hershey AD, Coffey CS, Group CS. The Childhood and Adolescent Migraine Prevention (CHAMP) Study: “What Do We Do Now?”. Headache. 2017;57(2):180–3.
Kroner JW, Hershey AD, Kashikar-Zuck SM, SL LC, Allen JR, Slater SK, et al. Cognitive behavioral therapy plus amitriptyline for children and adolescents with chronic migraine reduces headache days to </=4 per month. Headache. 2016;56:711–6.
Jackson JL. Pediatric migraine headache—still searching for effective treatments. N Engl J Med. 2017;376(2):169–70.
Faria V, Kossowsky J, Petkov MP, Kaptchuk TJ, Kirsch I, Lebel A, et al. Parental attitudes about placebo use in children. J Pediatr. 2017;181:272–8 e10.
Faria V, Linnman C, Lebel A, Borsook D. Harnessing the placebo effect in pediatric migraine clinic. J Pediatr. 2014;165(4):659–65.
Powers SW, Andrasik F. Biobehavioral treatment, disability, and psychological effects of pediatric headache. Pediatr Ann. 2005;34(6):461–5.
Eccleston C, Palermo TM, Williams AC, Lewandowski Holley A, Morley S, Fisher E, et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev. 2014;5:CD003968.
•• Powers SW, Kashikar-Zuck SM, Allen JR, LeCates SL, Slater SK, Zafar M, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013;310(24):2622–30. Results of an RCT demonstrating effectiveness of CBT for migraine management in children.
Ernst MM, O'Brien HL, Powers SW. Cognitive-behavioral therapy: how medical providers can increase patient and family openness and access to evidence-based multimodal therapy for pediatric migraine. Headache. 2015;55(10):1382–96.
Eccleston C, Palermo TM, WA C, Lewandowski A, Morley S, Fisher E, et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev. 2012;12:CD003968.
Holroyd KA. Management of migraine and tension-type headaches. In: Trafton J, editor. Best practices in the behavioral management of chronic disease: neuropsychiatric disorders, vol. 1. Los Altos: Institute for Disease Management; 2003.
Smitherman TA, Wells RE, Ford SG. Emerging behavioral treatments for migraine. Curr Pain Headache Rep. 2015;19(4):13.
Smith SM, Dworkin RH, Turk DC, Baron R, Polydefkis M, Tracey I, et al. The potential role of sensory testing, skin biopsy, and functional brain imaging as biomarkers in chronic pain clinical trials: IMMPACT considerations. J Pain. 2017;18(7):757–77.
Youssef AM, Ludwick A, Wilcox SL, Lebel A, Peng K, Colon E, et al. In child and adult migraineurs the somatosensory cortex stands out... again: an arterial spin labeling investigation. Hum Brain Mapp. 2017;38(8):4078–87.
Hubbard CS, Becerra L, Smith JH, DeLange JM, Smith RM, Black DF, et al. Brain changes in responders vs. non-responders in chronic migraine: markers of disease reversal. Front Hum Neurosci. 2016;10:497.
Simons LE, Pielech M, Erpelding N, Linnman C, Moulton E, Sava S, et al. The responsive amygdala: treatment-induced alterations in functional connectivity in pediatric complex regional pain syndrome. Pain. 2014;155(9):1727–42.
Becerra L, Sava S, Simons LE, Drosos AM, Sethna N, Berde C, et al. Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome. Neuroimage Clin. 2014;6:347–69.
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Kroon Van Diest, A.M., Ernst, M.M., Slater, S. et al. Similarities and Differences Between Migraine in Children and Adults: Presentation, Disability, and Response to Treatment. Curr Pain Headache Rep 21, 48 (2017). https://doi.org/10.1007/s11916-017-0648-2
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DOI: https://doi.org/10.1007/s11916-017-0648-2