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Objective: To assess agreement for migraine day between self‐report and diagnostic guidelines for children and adolescents using a headache diary. Background: Trial guidelines recommend prospective collection of headache features and adoption of migraine day as an outcome measure, but there is no clear consensus on the definition of migraine day. Methods: This is a secondary analysis of data from two projects—a prospective cohort study validating a pediatric scale of treatment expectancy and a clinical trial of occipital nerve blocks to treat status migrainosus. Participants completed a text message‐based diary for 4 or 12 weeks (depending on treatment), and a detailed headache assessment on a random 20% of headache days. Using this assessment, we determined whether a headache day qualified for migraine or probable migraine, based on the International Classification of Headache Disorders, 3rd edition (ICHD‐3). Results: Of 122 enrolled children and adolescents, 106 (86.9%) completed ≥1 detailed headache assessment (438 entries). We found moderate agreement between self‐reported and ICHD‐derived migraine day, with a Cohen's Kappa of 0.50 (positive predictive value [PPV]: 0.66; negative predictive value [NPV]: 0.85; correlation: 0.51). Allowing for ICHD‐derived probable migraine significantly increased PPV (0.66 vs. 0.94; 95% CI: 0.57–0.74 vs. 0.90–0.97), but decreased NPV (0.85 vs. 0.293; CI: 0.77–0.90 vs. 0.199–0.40), Cohen's Kappa (0.50 vs. 0.237; CI: 0. 389–0.60 vs. 0.139–0.352), and correlation (r = 0.51 vs. 0.302; CI: 0.41–0.61 vs. 0.192–0.41). Pain severity (OR: 5.7; CI: 2.39–13.8), photophobia (OR: 4.1; CI: 1.02–16.6), and phonophobia (OR: 7.5; CI: 1.95–29.3) were significantly associated with participants' perception of migraine. Conclusion: We found only moderate agreement between self‐reported and ICHD‐derived migraine day, suggesting both measures are not equal but may represent overlapping aspects of migraine as a disease. This highlights the difficulty of applying ICHD criteria to individual attacks. We recommend greater methodological transparency in future research to avoid readers conflating both measures. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect size, safety, and tolerability of a therapist‐independent biofeedback treatment app among adolescent with migraine. Materials and Methods: This was a prospective, 3:1 ratio randomized, sham‐controlled, double‐blind, pilot study with 16 adolescents diagnosed with migraine randomized to eight weeks of biofeedback treatment (n = 12) or sham biofeedback (n = 4), carried out at two university hospitals in Norway. The prespecified and primary objective of the study was to observe changes in outcomes within the active treatment group. The sham control group was included in a minor ratio primarily to evaluate its feasibility. The primary outcome was change in headache frequency. A modified intention to treat analysis was performed, including participants completing at least seven biofeedback sessions in weeks 1–4 (n = 12 vs. n = 4) and weeks 5–8 (n = 7 vs. n = 2). Results: Adherence was poor with 40% (136/336) of planned biofeedback sessions completed during weeks 5–8. Within the biofeedback group, a not statistically significant reduction in headache frequency was observed at weeks 1–4 (2.92 days/month, 95% CI −1.00 to 6.84, p =.145) and weeks 5–8 (1.85 days/month, 95% CI −2.01 to 5.72, p =.395). The biofeedback group experienced a median of one fewer headache days/month versus sham that did not reach significance (95% CI −4.0 to 9.0, p =.760). Conclusions: We observed a small reduction in headache frequency in the active treatment group. Findings were likely undermined by low adherence and underpowered analyses but indicate that a therapist‐independent biofeedback treatment app has the potential to be an effective, tolerable, and inexpensive treatment option. [ABSTRACT FROM AUTHOR]

Introduction: OnabotulinumtoxinA is approved in the USA for the prevention of headache in adults with chronic migraine, a debilitating neurologic disease characterized by headaches occurring on ≥ 15 days per month for > 3 months and including migraine features on ≥ 8 days per month.Objective: The COMPEL Study (NCT01516892), a 108-week, multi-center, open-label study, evaluated the long-term efficacy and safety of onabotulinumtoxinA in adults with chronic migraine. The objective of this subanalysis was to examine the safety and tolerability of onabotulinumtoxinA after each of nine treatment cycles.Methods: OnabotulinumtoxinA 155 U was administered every 12 weeks. Safety and tolerability, overall and by treatment cycle, were assessed. Treatment-emergent adverse events reported between successive treatments were attributed to the preceding treatment. The safety population received one or more doses of onabotulinumtoxinA. The primary efficacy outcome was the reduction in headache days at week 108 compared with baseline.Results: Of 716 patients enrolled, 373 patients (52.1%) completed the study and 343 (47.9%) withdrew; 481 patients (67.2%) received 60 weeks of treatment and 402 (56.1%) received 108 weeks of treatment. In total, 436 (60.9%) patients reported treatment-emergent adverse events; most were mild/moderate in severity. Thirty-two patients (4.5%) discontinued the study after experiencing treatment-emergent adverse events. The incidence of treatment-emergent adverse events typically decreased with repeated onabotulinumtoxinA treatment: first cycle, 24.2%; fourth cycle, 18.4%; ninth cycle, 12.2%. Neck pain (2.7%), eyelid ptosis (1.8%), musculoskeletal stiffness (1.4%), injection-site pain (1.3%), and headache (1.3%) were the most common treatment-emergent adverse events after the first cycle. Seventy-five patients (10.5%) reported serious treatment-emergent adverse events, 13 (1.8%) withdrew. Treatment-related adverse events were reported by 131 patients (18.3%), one was considered serious. OnabotulinumtoxinA significantly reduced headache day frequency by 10.7 (6.4) days per 28-day period (p < 0.0001) at week 108.Conclusions: OnabotulinumtoxinA treatment was well tolerated over 108 weeks; no new safety signals were identified. The overall incidence of treatment-emergent adverse events and the most common individual events decreased with repeated onabotulinumtoxinA administration.Clinical Trial Registration: ClinicalTrials.gov; NCT01516892. [ABSTRACT FROM AUTHOR]

Aim: To examine the characteristics of visual symptoms during attacks of migraine in children and adolescents.Method: A qualitative analysis of prospectively collected data over 5 years, on characteristics of visual symptoms during migraine attacks. Diagnosis of migraine and aura was based on the International Classification of Headache Disorders 3rd edition beta version. We also provided the opportunity for patients to illustrate their visual aura symptoms to aid in diagnosis.Results: Visual symptoms were reported by 387/1079 (36%) of migraineurs. Of these, 172 (16%) patients fulfilled the International Classification of Headache Disorders Criteria A, B, C iv and D, but missed one (n = 75; 43.5%) or two (n = 97; 56.5%) of the remaining items of criteria C as the visual symptoms were of non-gradual spread (n = 35; 20%), appeared in both visual fields (n = 99; 58%), or lasted less than 5 minutes or more than 60 minutes (n = 129; 75%).Conclusion: The International Classification of Headache Disorders 3rd edition beta version criteria are useful in diagnosis of migraine with visual aura in children and adolescents, but visual symptoms varied considerably in duration, pattern, mobility, location, mode of onset and colours. Providing opportunity for patients to illustrate their symptoms can provide additional diagnostic information. The pathophysiology and the clinical concept of typical MVA is still to an extent an assumption and needs further evaluation.Approval: The study was approved by the Health Research Authority - London and the local Research and Innovation Department at Barking Havering and Redbridge National Health Service Trust. Formal parental consent was not considered essential for this type of study. [ABSTRACT FROM AUTHOR]

Background: Effective management of migraine requires adherence to treatment recommendations; however, adolescents with migraine take their daily medications only 75% of the time. Low-cost adherence-focused interventions using technology may improve adherence, but have not been investigated.Methods: Thirty-five adolescents and young adults (13-21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone adherence-promotion application ("app") and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention.Results: Relative to baseline, adherence significantly improved during the first month of the intervention. Specifically, improvements existed for older participants with lower baseline adherence. Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates. Participants rated the intervention as acceptable and easy to use.Conclusions: "Apps" have the potential to improve medication adherence and are a promising intervention for adolescents and young adults with low adherence. Involving parents in the intervention is also helpful. Providers should assess barriers to adherence and use of technology-based interventions, encourage parents to incorporate behavioral incentives, and provide referrals for more intensive interventions to improve long-term outcomes. Further, tracking adherence in an app may result in an underestimation of adherence. Future full-scale studies should be conducted to examine adherence promotion app interventions. [ABSTRACT FROM AUTHOR]

Background Quality clinical trials form an essential part of the evidence base for the treatment of headache disorders. In 1991, the International Headache Society Clinical Trials Standing Committee developed and published the first edition of the Guidelines for Controlled Trials of Drugs in Migraine. In 2008, the Committee published the first specific guidelines on chronic migraine. Subsequent advances in drug, device, and biologicals development, as well as novel trial designs, have created a need for a revision of the chronic migraine guidelines. Objective The present update is intended to optimize the design of controlled trials of preventive treatment of chronic migraine in adults, and its recommendations do not apply to trials in children or adolescents. [ABSTRACT FROM AUTHOR]

Background No study dedicated to postdrome symptoms of migraine attacks is available in children and adolescents. Objective To study the resolution phase of the migraine attack in children and adolescents. Methods 100 children and adolescents with ICHD-3 beta migraine without and/or with typical aura were included. Each patient, and one of her/his parents, were interviewed by phone about the postdrome phrase of their last six months’ migraine attacks. They were specifically instructed to distinguish symptoms that had begun before and went on after migraine headache cessation (referred to as persistent symptoms), and symptoms whose onset was strictly after headache cessation (referred to as true postdromes). Results 91% of patients reported persistent symptoms, with a mean of 2.9 and a median of 2; asthenia, cognitive difficulties, pallor, cognitive slowing, anorexia, somnolence, and nausea were the most frequently reported. They lasted less than 12 h in 71% of patients. True postdromes were reported by 82% of patients, with a mean of 2.6 and a median of 2; thirst, somnolence, visual disturbances, food craving, paraesthesias, and ocular pain being the most frequently reported. They lasted less than 12 h in 94% of patients. Conclusions This study showed that children and adolescents with migraine had both frequent persistent symptoms and true postdromes. Both were notably different from those reported in adults. [ABSTRACT FROM AUTHOR]

Background Fifty-three percent of adolescent girls report headaches at the onset of menses, suggesting fluctuations of ovarian hormones trigger migraine during puberty. Aims To determine if urinary metabolites of estrogen and progesterone are associated with days of headache onset (HO) or severity in girls with migraine. Methods This was a pilot study and included 34 girls with migraine balanced across three age strata (pre-pubertal (8-11), pubertal (12-15), and post-pubertal (16-17) years of age). They collected daily urine samples and recorded the occurrence and severity of headache in a daily diary. Urine samples were assayed for estrone glucuronide (E1G) and pregnandiol glucuronide (PdG) and the daily change was calculated (ΔE1G, ΔPdG). Pubertal development was assessed by age, pubertal development score (PDS), and menstrual cycle variance. The primary outcome measures were HO days and headache severity. Generalized linear mixed models were used, and included the hormonal variables and three different representations of pubertal development as covariates. Results Models of HO days demonstrate a significant age*PdG interaction (OR 0.85 [95% CI 0.75, 0.97]) for a 1 standard deviation increase in PdG and three-year increase in age. A separate model showed a significant PDS*PdG interaction (OR -0.85 [95% CI; 0.76, 0.95]). ΔPDG was associated with headache severity in unadjusted models ( p < 0.017). Conclusion Age and pubertal development could moderate the effect of ovarian hormones on days of headache onset in girls with migraine. [ABSTRACT FROM AUTHOR]

Background Migraine is a common and disabling neurological disorder. Studies on the relationship between migraine and the autonomic nervous system ( ANS) have been inconclusive. Moreover, pediatric studies are extremely limited. Therefore, the present study investigated interictal ANS function in adolescent migraineurs. Methods We studied 21 patients with migraine and 26 healthy controls. Beat-to-beat blood pressure ( BP) and heart rate ( HR) were non-invasively and continuously measured in the supine and standing positions. ANS function was evaluated on power spectral analysis of HR variability and diastolic BP ( DBP) variability. Results Heart rate and systolic BP were not different between the two groups in either the supine or standing position. DBP did not differ between groups in the standing position, but was significantly higher in migraineurs in the supine position. The vasoconstrictor index was significantly higher in migraineurs. High-frequency ( HF) RR interval variability ( RR- HF) and the ratio of the low-frequency ( LF) to HF component of RR interval variability ( RR- LF/ HF) were not different between the two groups in both positions. The LF component of DBP variability ( DBP- LF) in the supine position was significantly lower in migraineurs, while DBP- LF during standing in migraineurs was significantly higher than in controls. Conclusion Migraineurs have significantly lower sympathetic vasomotor activity in the supine position, while sympathetic vasomotor activity was hyperresponsive during standing. [ABSTRACT FROM AUTHOR]

Recognize the presence of headache at early age is essential to prevent that the disorder interferes with physical, psychological and social functioning. However, there are several differences between adults and children in the clinical manifestation of headache such as quality and severity of pain, trigger, associated symptoms, gender, duration of attacks, number of daytime attacks, comorbidities and red flags of secondary headache. These differences can make the diagnosis more complex in early ages than in adults, so it is essential to know how headache changes over time to identify its presence in the earliest phases of childhood. [ABSTRACT FROM AUTHOR]

Nutraceutics are the most used non-pharmacological remedies for migraine's prophylaxis in children and adolescents. Doctors interested in use of nutraceuticals for a complete treatment of children's headache should be adequately informed on this treatments' efficacy and safety. Actually there is a lack of official guidelines about use of nutraceuticals in migraine's prevention in children and adolescent and there are few studies with limited efficacy evidences. The most used nutraceuticals for adolescent's and children's headache prophylaxis are: magnesium, coenzyme Q10, riboflavin, butterbur, feverfew and melatonin. Further Randomised Controlled Trials are needed for a better effectiveness evaluation in nutraceuticals' use for migraine treatment in child and adolescent. [ABSTRACT FROM AUTHOR]

Aim: The aims of this study were to investigate comorbid psychiatric disorders and to identify anxiety and depression levels and quality of life in children and adolescents with migraine; and to assess their relationship with migraine. Method: 35 patients aged 9-16 years were followed in our neurology clinic and their parents were included into the study. 35 age- and sex-matched patients were employed as the control group. In the subjects included, psychiatric disorders were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version. All children and adolescents were assessed by using the Children’s Depression Inventory, the State-Trait Anxiety Inventory and the Pediatric Quality of Life Inventory. In addition, the Pediatric Migraine Disability Assessment Tool and visual analog scale were used to identify the degree of disability and pain severity in patients with migraine. Findings: In the psychiatric assessment of children and adolescents with migraine, it was found that a psychiatric diagnosis was made in 40% of patients; and depression scale scores were significantly higher than those of controls. Quality of life was found to be poorer in patients with migraine compared to controls. It was found that quality of life was negatively correlated with pain severity and degree of disability; while it was positively correlated with depression scores. Discussion: In children and adolescents with migraine, treatment of psychiatric disorders in addition to migraine therapy can facilitate migraine management and may decrease the need for prophylactic therapy. [ABSTRACT FROM AUTHOR]

Background: Migraine is common in children and adolescents and can be disabling. Being able to predict which patients will respond to triptans based on their clinical phenotype would be helpful. Adult data suggest cranial autonomic symptoms and aura predict triptan response. This study examined clinical predictors of triptan response in pediatric migraineurs.Methods: This chart review study included all patients less than 18 years old with migraine who were seen at the University of California, San Francisco Headache Center in 2014. Univariate χ(2) analyses were performed, followed by multivariate logistic regression modeling.Results: Of 127 pediatric migraineurs, 70 (55%) had chronic migraine and 24 (19%) had aura. The majority (55%) had at least one cranial autonomic symptom. Of 65 with triptan outcome data, 47 (73%) benefitted from a triptan. In univariate analyses, triptan benefit was seen in 65% with chronic migraine versus 88% with episodic migraine (P = 0.048), 67% with aura versus 74% without (P = 0.66), and 70% with cranial autonomic symptom versus 74% without (P = 0.76). In a multivariate logistic regression model, chronic migraine, aura, and cranial autonomic symptom were not statistically significant predictors of triptan benefit: chronic migraine: 0.25 (0.06-1.04); aura: 0.65 (0.09-4.45); cranial autonomic symptom: 0.75 (0.22-2.52).Conclusions: In univariate analysis, individuals with chronic migraine were less likely to benefit from triptans. In contrast to what has been documented in adults, cranial autonomic symptoms and aura did not predict triptan response, although our small sample size limited the study's power. Larger pediatric studies are needed, and future pediatric triptan trials should provide response rates stratified by clinical variables such as aura. [ABSTRACT FROM AUTHOR]

Background: Reports have suggested that abnormal cortical excitability may be associated with acute migraines. The present study quantitatively assesses the degree of cortical excitability in chronic migraine as compared to acute migraine and healthy controls within the pediatric population. Methods: We investigated 27 children suffering from chronic migraine, 27 children suffering from acute migraine, and 27 healthy controls using a magnetoencephalography (MEG) system, recording at a sampling rate of 6000 Hz. All groups were age-matched and gender-matched. Neuromagnetic brain activation was elicited by a finger-tapping motor task. The spatiotemporal and spectral signatures of MEG data within a 5-2884 Hz range were analyzed using Morlet wavelet transform and beamformer analyses. Results: Compared with controls, the chronic migraine group showed (1) significantly prolonged latencies of movement-elicited magnetic fields (MEFs) between 5 and 100 Hz; (2) increased spectral power between 100 and 200 Hz, and between 2200 and 2800 Hz; and (3) a higher likelihood of neuromagnetic activation in the ipsilateral sensorimotor cortices, supplementary motor area, and occipital regions. Compared with acute migraine group, chronic migraine patients showed (1) significantly higher odds of having strong MEFs after 150 ms; and (2) significantly higher odds of having neuromagnetic activation from the deep brain areas. Conclusions: Results demonstrated that chronic migraine subjects were not only different from the healthy controls, but also different from acute migraine subjects. The chronification of migraines may be associated with elevated cortical excitability, delayed and spread neural response, as well as aberrant activation from deep brain areas. [ABSTRACT FROM AUTHOR]

Purpose Interpersonal relationships are viewed as important contexts within which psychopathology emerges and persists or desists. Attachment theory describes the dynamics of long-term relationships between humans especially in families and lifelong friendships. The present study was aimed at investigating attachment styles in adult patients with epilepsy as compared to subjects with migraine and their potential correlates with a history of mood disorders. Methods A consecutive sample of 219 adult outpatients with epilepsy (117) or migraine (102) was assessed with the Attachment Style Questionnaire (ASQ). Results Patients with epilepsy and a lifetime history of mood disorders presented elevated scores for Need for approval (p < 0.001) and Preoccupation with relationships (p < 0.001). Age correlated with the Relationships as secondary (r = 0.322; p < 0.001) and Need for approval (r = 0.217; p = 0.019) subscales while age at onset correlated only with Relationships as secondary (r = 0.225; p = 0.015). Seizure-free patients presented lower scores for Need for approval (p = 0.003). Patients with migraine and a lifetime history of mood disorders presented lower scores in Confidence (p = 0.002) and higher scores in Discomfort with closeness (p = 0.026). Conclusions An anxious–preoccupied attachment correlated with mood disorders in epilepsy while it was an avoidant pattern in migraine. Our results bring further data on the role of psychological variables in mood disorders in epilepsy. Further studies will allow early identification of patients at risk and the development of preventive strategies. [ABSTRACT FROM AUTHOR]

Objective Follow-up studies of children and adolescents with epilepsy ( CAW-E) have revealed higher risk of mortality than children in the general population. The mortality experience of CAW-E relative to patients with other common neurologic disorders in the pediatric age group is yet undetermined. The objectives of this study are the following: (1) to compare the causes and the adjusted risk of death in CAW-E with that of children and adolescents with migraine ( CAW-M) in reference to children and adolescents with lower extremity fracture ( CAW- LEF), and children and adolescents in the general population; (2) to evaluate if disparate mortality risks exist by demographic characteristics. Methods This retrospective cohort study included 56,781 children and adolescents 0-18 years of age hospitalized or treated in an emergency or outpatient department from 2000 to 2011 for epilepsy, migraine, or lower extremity fracture from all nonfederal health care facilities. Data on deaths were acquired from linked multiple causes of death data file using person-specific unique identifiers. Time of follow-up was from initial clinical encounter to time of death or censoring date of December 31, 2011. The association of risk characteristics with mortality was examined with Cox proportional hazard model after adjusting for potential confounders. Results Four hundred forty-seven CAW-E and 125 CAW-M died yielding mortality rates of 8.71 and 1.36 per 1,000 person-years, respectively. The 5-year risk of death was 4.38% for CAW-E, 0.68% for CAW-M, and 0.71% for CAW- LEF. Adjusted hazard ratios ( HRs) were 3.81 (95% confidence interval [ CI] 3.08-3.72) in CAW-E and 1.14 (95% CI 0.94-1.34) in CAW-M relative to CAW- LEF. Risk of death from neurodevelopmental comorbidities was 5.86 (95% CI 4.24-8.08) times greater than those without in the model that compared epilepsy with LEF. Significance There is an elevated risk of death in CAW-E with neurodevelopmental comorbidities that remains to be proven. [ABSTRACT FROM AUTHOR]

Migraine is a common condition that for many begins in childhood and may progress over the course of one's life. The transition from adolescence to adulthood is a critical time for those who suffer from migraine and can be marked by a variety of important considerations for the patient and practitioner. Medication choices may be a challenge during adolescent years as Food and Drug Administration (FDA) approved options are few and many more studies are needed to understand the benefits and risks of use of these agents in adolescents. However, as patients transition to adulthood, FDA approved options and the level of evidence improve significantly. Late adolescents may also struggle with a variety of psychiatric comorbidities that may simultaneously create challenges in determining treatment but also open opportunities to manage multiple comorbidities and address underlying depression, anxiety, and behavioral issues. For late adolescent girls, the beginning of sexual activity, onset of gynecologic conditions, or presence of irregular or painful menses may raise questions regarding the use of oral contraceptives (OCs). Given data on the risks of these medications in women with migraine, especially those with aura or those who smoke, important conversations between physicians and their migraine patients can help risk stratify and determine the risk/benefit profile for the potential use of these agents. Much more data are needed to fully understand the transition from adolescence to adulthood for those suffering with migraine and this article seeks to shed light on the limited understanding currently available in established literature. [ABSTRACT FROM AUTHOR]

This study compared superoxide dismutase (SOD) and catalase (CAT) alleles in 97 consecutive children and adolescents with migraine to 96 healthy children and adolescents. Isolated genomic DNA was used as a template for SOD1 (35 A/C), SOD2 16 C/T, and CAT2 [(–262 C/T) and (–21 A/T)] allele genotyping. The SOD2 16 C/T genotype and C allele frequency differed significantly between controls and migraine (P = .047; P = .038). CAT –21 AA genotype and A allele frequency were significantly higher in both migraine with aura patients (P = .013; P = .004) and migraine without aura patients (P = .003; P = .001) compared to controls. To our knowledge, this is the first demonstration of differences in SOD and CAT genotypes between pediatric migraine patients and age-matched controls. Further studies on the functional implications of these genetic variants on neural antioxidant capacity and the use of antioxidant modulators for migraine treatment are warranted. [ABSTRACT FROM AUTHOR]

Background: Tension-type headache and migraine are among the most prevalent chronic disorders in children/adolescents. Data on health care utilization for headache in this age group, however, are sparse. Methods: In 1399 grammar school students (aged 12-19 years) with headache in the last six months in Germany a) the burden of disease for headache (mean intensity, mean frequency in the last three months and PedMIDAS means), b) medical care utilization defined by proportion of students consulting a physician in the last 12 months and/or taking analgetic drugs in the last three months by headache types (migraine and tension-type headache) and by burden of disease were assessed. Results: Primary headache substantially impaired daily living activities in adolescents which was mainly related to migraine. Medical care utilization and drug use, however, was low (consulting a physician: 12.0 %, 95 %-CI = [10.3-13.8]; taking analgetic drugs: 29.9 %, 95 %-CI = [27.5-32.4]) - even among students with severe headache (physician consultation: <35 %; taking analgetic drugs: <63 %). Two thirds of students with any headache and 40 % of those with migraine had neither seen a physician nor used analgetic drugs because of their headache in the preceding 12 months. Conclusions: Adolescents with headache might too rarely seek professional help for treatment of headache. Health promotion in adolescents should increase awareness for evidence-based treatment options for headache. [ABSTRACT FROM AUTHOR]

Migraine prevalence increases from infancy to adolescence thus suggesting the important role of adolescent somatic and emotional maturation in supporting the disease. New family and society relationship and scholastic experiences represent more or less stress moments, producing risk factors for adolescent migraine. There are few studies adequately assessing migraine treatment efficacy in adolescent attack and prevention. Adolescent migraine's treatment with pharmacological and nonpharmacological therapies needs an individualized approach considering adolescent development degree, risk factors and trigger circumstances, psychological correlates and even psychiatric or other comorbidities. [ABSTRACT FROM AUTHOR]

Background and purpose: Migraine is a kind of primary headache that involves neurovascular system. Some studies have shown that obesity could affect the severity, frequency and duration of migraine attacks. This study aimed at investigating the association between anthropometric measurements and severity, frequency and duration of headache in patients with migraine. Material and methods: This descriptive-correlational study was conducted in 100 migraine patients who referred to Isfahan Korshid and Imam Mosua Sader Clinics in 2013. Anthropometric measurements such as weight, height, Body Mass Index (BMI), Body Fat Mass (BFM) and Waist Circumference (WC) were measured for each patient. Data was analyzed by SPSS V.19 using t-test, X² and regression tests. Results: The mean of patients' BMI, BFS and WC in men and women was 24.46±4.45 and 24.72±4.58kg/m², 17.66±8.12 and 20.12±7.31 kg, 88.62±11.68 and 80.81±9.03 cm, respectively. The mean of severity, frequency and duration of migraine attacks in men and women was 6.96±0.92 and 7.15±0.92, 11.21±8.68 and 11.26±10.16 per month, 18.19±16.16 and 21.75±18.63 hours, respectively. In total population, BMI, BFS and WC had significant effect on severity and frequency of migraine attacks (P< 0.01). While, no significant association was found between anthropometric measurements and duration of migraine attacks (P>0.05). Conclusion: In this study, the mean of BMI, BFM and WC, (the indices of central and general obesity) were in appropriate levels but these indices had significant role in severity and frequency of migraine attacks. However, no significant relationship was seen between mentioned measurements and duration of migraine attacks. [ABSTRACT FROM AUTHOR]

Background There is a paucity of pediatric data addressing the complex relationship between primary headaches and sleep disturbances. Our study objective was to explore headache-related factors that predict sleep disturbance and to compare sleep complaints with other forms of headache-related disability among youth with migraines. Methods A prospective cohort study was conducted in patients 10-18 years old with migraine or probable migraine and without daily sleep complaints. The patients completed a 90-day internet-based headache diary. On headache days, patients rated headache intensity, answered Pediatric Migraine Disability Assessment-based questions modified for daily scoring, and reported sleep disturbances that resulted as a direct effect of proximate headaches. Results Fifty-two patients generated 4680 diary entries, 984 patients (21%) involved headaches. Headache intensity ( P = 0.009) and timing of headache onset ( P < 0.001) were predictive of sleep disturbances. Three Pediatric Migraine Disability Assessment-based items were also associated with sleep disturbances: partial school-day absence ( P = 0.04), recreational activities prevented ( P < 0.001), and decreased functioning during recreational activities ( P < 0.001). Sleep disturbances correlated positively and significantly with daily headache disability scores ( r pb = 0.35; P < 0.01). Conclusion We conclude that specific headache factors predict sleep disturbances among youth with primary headaches. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present analysis is to confirm or refute the association of neck pain to migraine or tension-type headache and to assess whether this association is independent of other risk factors for headache. Methods: Secondary school students were invited to complete a questionnaire on headache and lifestyle factors in a cross-sectional study. Neck pain was assessed via (a) a screening question concerning neck pain and (b) denoting affected areas in schematic drawings of the human body. Results: Absolute increment in prevalence of headache with pain in the shoulder-neck region was between 7.5% and 9.6%. Gender, grade, stress and lifestyle factors were assessed as potential confounding factors. Nearly all factors were associated with shoulder-neck pain and most with headache. After adjustment for confounders, the association of neck pain with headache was almost completely confined to migraine (OR 2.39; 95% CI 1.48-3.85) and migraine+tension-type headache (OR 2.12; 95% CI 1.50-2.99), whereas the association with isolated tension-type headache was negligible (OR 1.22, 95% CI 0.87-1.69). Conclusion: Neck pain is associated with migraine but not with tension-type headache. A possible link between migraine and neck pain may be the cervico-trigeminal convergence of neck and meningeal sensory afferents or a disturbed descending inhibition in migraine. [ABSTRACT FROM AUTHOR]

The article discusses research on the efficacy and tolerability of oral sumatriptan in the treatment of migraine in children and adolescents. The study involved 178 patients from 17 centers in Japan, who were randomized to receive sumatriptan or placebo. Based from the results of the study, the authors determined a lack of significant improvement between sumatriptan and placebo for pain relief at two hours.

Background: Headaches are often under-diagnosed in adolescents. The aim of this study was to examine the one-yearprevalence of primary headaches among high school students in the city of Zagreb, the capital of Croatia.Methods: This was a population-based, cross-sectional study. A total of 2350 questionnaires consisting of questions ondemographic data, the presence and clinical characteristics of headaches were distributed among students in eight highschools; 2057 (87.5%) questionnaires were eligible for analysis.Results: The mean age of the students was 17.2±1.2 years; 50.2% were female. The prevalence of recurrent headachewas 30.1% (620/2057), girls 35.1%, boys 25.2%. Among students with headache, 291 (46.9%) had migraine, and 329(53.1%) had tension-type headaches (TTHs). The mean frequency of headaches was 5.66 per month in girls and 4.42 inboys; mean duration of a headache attack was 8.94 hours in girls and 8.37 hours in boys (NS). Unilateral headache waspresent in 31.6%, throbbing quality in 22.6%, dull in 34.4% of students; 22.4% had severe intensity and 70.3% moderate.Nausea was present in 4.0% always and in 14.7% frequently (girls 18.8%), photophobia in 41.3%, phonophobia in 63.2%,osmophobia in 23.9% (NS among genders). Almost 30% of students were disabled and stayed at home, more frequentlyboys. Girls (33.4%) were more likely to take drugs for every attack; number per month was 3.7. The results of this studyshowed that the prevalence of migraine among adolescents in Croatia was 16.5% for girls and 11.8% for boys; theprevalence of TTH was 18.4% for girls and 13.4% for boys.Conclusions: The prevalence of self-reported headache among high school students in Zagreb is relatively high. Significantgender differences in frequency and clinical characteristics were observed. Primary headaches among adolescents are animportant public health problem and should receive more attention from school and health authorities. [ABSTRACT FROM AUTHOR]

Abstract: Background: The etiology and clinical importance of white matter lesions in migraine remain poorly understood. To understand these issues more fully, we reviewed the brain magnetic resonance imaging scans of pediatric patients and assessed the relationships between white matter lesions, migraine type, patent foramen ovale, and right-to-left shunting. Methods: The magnetic resonance imaging scans of a cohort of children (n = 89) and adolescents, ages 6 to 18 years, who participated in a study of migraine and patent foramen ovale were reviewed. All children in the cohort had undergone saline contrast transthoracic echocardiography and transcranial Doppler studies. Results: White matter lesions were detected in 15 of the 89 patients (17%). White matter lesions were small (<5 mm) in the majority (10/15; 66%). We observed no relationship between the presence of white matter lesions and (1) migraine type (six patients with white matter lesions among 35 with migraine with aura [17%] vs. nine with white matter lesions among 54 without aura [17%]; P = 1.0); (2) patent foramen ovale (five with white matter lesions among 35 with patent foramen ovale [14%] vs. 10 with white matter lesions among 54 without patent foramen ovale [19%]; P = 0.77); or (3) shunt size (two large shunts in 15 with white matter lesions [13%] vs. nine large shunts among 72 without white matter lesions [13%]; P = 1.0). Conclusions: These results indicate that small white matter lesions are not infrequent in children and adolescents with migraine. However, no relationships between white matter lesions and migraine type, patent foramen ovale, or degree of right-to-left shunting were observed. [Copyright &y& Elsevier]

Migraine is a common disease in children and adolescents. The incidence of migraine has increased alarmingly in the general population during recent decades. Migraine causes considerable individual suffering and impaired quality of life. Therefore, appropriate management is essential. In this article, the treatment of acute migraine in children and adolescents will be reviewed. Only a few randomized controlled studies have been published and high placebo rates are a major problem for proving superiority of active drugs. Generally, acetaminophen (paracetamol) and ibuprofen are accepted as drugs of first choice, even though the evidence is poor for the former and limited for latter. Among 14 studies on triptans in adolescents, 9 showed some superiority over placebo with respect to pain relief and pain freedom, and among 6 studies in children, 5 suggest some superiority over placebo. Sumatriptan nasal spray and zolmitriptan nasal spray have been approved for adolescents in Europe; almotriptan has been approved for adolescents in the USA, as has rizatriptan for patients aged 6-17 years. A recent study demonstrated the efficacy of a fixed combination of sumatriptan and naproxen in adolescents with migraine. In conclusion, evidence for the pharmacological treatment of acute migraine in children is very poor and evidence for adolescents is better but still limited. [ABSTRACT FROM AUTHOR]

Patients with chronic migraine (CM) headaches present some of the most difficult treatment challenges for headache practitioners. Attention to psychological and behavioral issues become significant treatment considerations as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is inadequate response to usually effective treatment. Recent research has identified a variety of risk factors (including medication overuse) that appear to be associated with the escalation of the frequency and severity of migraine headache and are amenable to behavioral (non-pharmacological) treatment. The present article will highlight therapies that may be effective in the treatment of patients with CM headache. [ABSTRACT FROM AUTHOR]

Background and purpose Migraine is the most important cause of headache leading to a decrease in the quality of life in children and adolescents. The prevalence of episodic (EM) and chronic migraine (CM) increases with increasing age, which especially focused in recent years. Methods To evaluate the prevalence and determinants of migraine in children and adolescents, we performed this school-based epidemiological study. First part of the study was performed in 2001 that included 5562 children. Second part of the study was performed in 2007 in adolescents including 1155 young. After the main reports published, we made a new analysis in the database that focused on migraine. Results Totally, 10.4% of the children, predominantly the girls, received the diagnosis of migraine when they grew older (1.7% CM, 8.6% EM). CM frequency increased with increasing ages (doubled at 12 years, P = 0.035). The significant risk factors for having CM were found to be age, gender, and father and sibling headache histories. Most of the clinical characteristics of migraine are far from classical knowledge in children with CM. In adolescents, 18.6% were diagnosed as migraine (1.5%CM, 17.1%EM) with a predominance of girls without age difference. When they reached puberty after 6 years, double the number of cases with CM was headache free. Most of the young changed their headache characteristics during the follow-up period independent from management strategies. Conclusions Our results showed that CM is an important cause of headache in both children and adolescents with some defining headache characteristics and risk factors concentrated in different age-groups. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate whether the symptoms of migraine and car sickness coexist or not. In addition, we tried to elucidate whether the car sickness can be a clinical indicator of diagnosing migraine in children. Methods : A total of 166 children and adolescents who had newly diagnosed migraine and followed up for more than 2 years after the termination of treatment were involved in the study. The co-morbidity or co-existence of symptoms between two conditions in the clinical course was investigated. Results : Sixty three of 124 who had car sickness as well as migraine recovered from migraine. Among these 63 patients, the car sickness disappeared in 44 (69.8%), decreased in 7 (11.1%) and persisted in 12 (19.0%). On the other hand, 23 of those 124 migraineurs continued to have migraine. In these patients, car sickness disappeared in 4 (17.4%), decreased in 5 (21.7%) and persisted in 14 (60.9%). The freedom or alleviation of car sickness is more common in children free from migraine than in children with persistent migraine (P< 0.001). Conclusion: The results suggest that migraine is closely related to car sickness in children and the clinical course of migraine generally overlaps those of car sickness. We therefore believe that car sickness can be a clinical indicator in the diagnosis of migraine. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the presence of pressure-painful scalp arteries in children and adolescents with migraine.Materials and methods: Pressure-painful points on scalp arteries were searched in 130 consecutive children (6–12 years old) and adolescents (>13 years old) affected with migraine, 89 females and 41 males, and in 40 age-matched controls.Results: In the absence of a migraine episode, we examined 76 patients: 54 (71.1%) reported one or more pressure-painful arteries and 22 reported none. Of the 40 controls, pressure-painful arteries were present in 11, with a highly significant difference (p < 0.0001).During a migraine attack, of the 54 patients examined, 43 (79.6 %) reported one or more pressure-painful arteries and 11 reported none. The arteries most frequently painful were the frontal branch and the superficial temporal artery.Conclusions: Scalp arteries are frequently painful on pressure in children and adolescents with migraine, both in the absence of and during a migraine attack. Painful arteries suggest hypersensitivity of periarterial nociceptive afferents. [ABSTRACT FROM PUBLISHER]

The relationship between blood pressure and headache in youth has not been explored and the objective of the present study was to provide data on this association in an adolescent population. Cross-sectional data from a large population-based survey, the Young-HUNT study, on 5,847 adolescents were used to evaluate the association between blood pressure (systolic, diastolic, mean arterial and pulse pressure) and recurrent headache, including migraine and tension-type headache. Increasing pulse pressure was inversely related to recurrent headache prevalence, and both tension-type headache and migraine. For systolic blood pressure such an inverse relationship was present for recurrent headache and tension-type headache prevalence. For migraine, the results were not significant, although there was a tendency in the same direction ( p = 0.05). High-pulse pressure has previously been found to be inversely related to the prevalence of migraine and tension-type headache in an adult population. This inverse relationship has now been demonstrated to be present among adolescents also, supporting the results from a previous study in adults, that blood pressure regulation may be linked to the pathophysiology of headache. [ABSTRACT FROM AUTHOR]

Abstract: Migraine is a neurological disorder characterized by unilateral head pain, nausea and/or vomiting and altered sensory perception (particularly phono- and/or photophobia). It is a common and disabling condition in children and adolescents, just as it is in adults; its origins, pathophysiology and long-term course are still not fully understood. Biological factors are currently held to be crucial in the aetiopathogenesis of primary headaches, such as migraine. In children and adolescents, we hypothesize that for migraine to develop, life events and their psychological processing are fundamental and can act in two different ways: either as a predisposing factor, inducing a chronic state of anxiety or depression (even subclinical), or as a trigger factor, activating a cascade of psychological events which, in turn, activate the biological mechanisms that produce the migraine attack. According to our hypothesis, psychological processing of life events (i.e. how the child perceives and mentally processes them) is the main factor in migraine aetiopathogenesis. This hypothesis has important implications in terms of diagnostic and therapeutic choices for children and adolescents with migraine. [Copyright &y& Elsevier]

Migraine headaches frequently occur in the pediatric population, with a prevalence of 3% in children 2–7 years of age, 4–11% in children 7–11 years of age, and 8–23% in children 11 years of age and older. Migraine without aura is more than twice as common as migraine with aura in children. Headaches are the third leading cause of emergency room referrals and rank in the top five health problems of children. The 2004 American Academy of Neurology’s treatment parameter for migraine in children and adolescents recommended that nasal sumatriptan be considered for acute treatment; however, data were lacking to make a decision regarding the available oral triptans at that time. The more recently released European guidelines discuss three different triptans for use in children but no specific triptan was recommended. Currently, six of the seven available triptans have been studied for efficacy and safety in the pediatric population; however, only a few well controlled clinical studies have been conducted. Sumatriptan has the most available data on outcomes in general, with nasal sumatriptan showing the most positive results. Nasal sumatriptan is approved in children older than 12 years of age in Europe. Oral sumatriptan does not show any clinical benefit versus placebo in children. Rizatriptan and zolmitriptan have conflicting efficacy and safety data, with most studies favoring the use of oral rizatriptan and nasal zolmitriptan. Almotriptan is the first triptan to obtain a US FDA indication in adolescents with migraines lasting 4 or more hours. This approval was based upon two studies, one large clinical trial and one very small, open-label, pilot study. At this time, there are insufficient data to recommend naratriptan and eletriptan for first- or second-line use in pediatric patients with migraines. There are currently no efficacy data for rovatriptan in pediatric patients, which limits its use in this population. Adverse effects of triptans and pharmacokinetic data in children and adolescents are similar to those in adults. The triptan class should be considered as an acute treatment option for children and adolescents with migraines, although their use is mostly 'off-label'. Of the available triptans, there are more positive efficacy data for sumatriptan and zolmitriptan nasal sprays, and rizatriptan and almotriptan tablets than for the other triptans. [ABSTRACT FROM AUTHOR]

( Headache 2010;50:1130-1143) Studying the prevalence of headaches at age extremes is of important clinical relevance. Pediatric studies inform us about determinants of incident disease; studies of elderly populations inform us about the long-term consequences of headaches, as well as about determinants of headache remission. As with other subspecialties of headache research, research on pediatric headache is an evolving field. However, although substantial advances have been achieved in understanding headaches in adolescents, knowledge of early childhood headaches is not as advanced conceptually. This review provides a theoretical framework for our current understanding, then summarize the results of a large, ongoing, epidemiological study in pre-adolescent children. It is clear that both in adolescents and in pre-adolescents, migraine is frequent. Diagnostic criteria for migraine and chronic migraine are certainly over-restrictive for young children. Migraine often lasts less than 1 hour in young children. A vulnerable population at risk of migraine progression also exists, likely reflecting increased biological predisposition, but also early life exposures. Indeed, it seems that even prenatal exposures of certain substances may increase the risk of migraine progression. Of relevance is the frequency of headaches within a family. Finally, migraine seems to be associated with behavioral hyperactivity, but is not comorbid with attention-deficit disorder and hyperactivity. [ABSTRACT FROM AUTHOR]

The aim of the investigation was to study the impact of headache on quality of life (QOL) in adolescents in a population-based sample (N = 1047, aged between 13 and 17 years). QOL was assessed using the KINDL-R (Revidierter Kinder Lebensqualitätsfragebogen) questionnaire with its six dimensions. In order to assess potential differences in the impact on QOL according to the type of headache, a stratified analysis was performed. QOL differences compared to the ‘no headache’ group are presented with adjustment for socio-demographic confounders. Headache at least once per month was reported in 48% of the adolescents and accounted for a small but significant reduction of 2.5 points in the total KINDL-R score, which was mainly caused by a reduction in physical wellbeing by 6.8 points. Adolescents with migraine reported higher reductions in physical wellbeing and total QOL than subjects with tension-type headache (TTH). The size of the reduction in QOL scores was small but similar to that observed for other chronic conditions in adolescents. Headache prevention programs might therefore have an impact on QOL in adolescents. [ABSTRACT FROM AUTHOR]

The long-term course of migraine with aura (MA) has been poorly explored. The present 11-year follow-up study assessed the long-term natural history and possible prognostic factors of MA with onset in childhood or adolescence. Patients were recruited from the original case records of our department, which are specifically designed to report all headache characteristics, aura symptoms and electroencephalogram (EEG) findings. A total of 77 patients (47 females; 30 males) whose records contained detailed descriptions of both headache and aura symptoms apparently meeting the International Classification of Headache Disorders (ICHD)-II criteria for MA (i.e., 1.2.1, 1.2.2, 1.2.6) underwent structured face-to-face follow-up headache interviews, all of which were conducted by the same neurologist, who has particular expertise in this field. A multivariate model (logistic regression analysis) was used to investigate the association between possible prognostic factors and the remission of both aura and headache at follow-up. The results of our study showed that 23.4% of the MA patients were headache-free at follow-up, 44.1% still had MA and 32.5% had a transformed headache diagnosis (i.e., fulfilling the criteria for ICHD-II 1.1. or 2). Patients with basilar-type migraine (1.2.6) showed the highest headache remission rate (38.5%).Our study seems to show that migraine with typical aura (1.2.1—1.2.2) is associated with a favourable evolution of aura symptoms over time (remission of aura in 54.1% of patients). Subjects experiencing only visual aura had a lower remission rate compared with those with visual ± sensory ± aphasic aura symptoms (36.8% vs. 61.5%, p = 0.054). A short headache duration (<12 hrs) and the presence of EEG abnormalities at baseline were the only significant predictors of aura remission at follow-up (odds ratio [OR] = 9.12, 95% confidence interval [CI]: 1.79 ± 46.51, and OR = 4.76, 95% CI: 1.18 ± 19.15, respectively). No significant predictors of headache remission were found.In conclusion, our results suggest that MA shows a favourable course. Further prospective studies with detailed EEG analysis both at baseline and at follow-up are needed in order to confirm the possible prognostic role of EEG abnormalities in MA. That said, it would, in our opinion, be highly premature at present to submit children with MA to EEG examinations for prognostication purposes. [ABSTRACT FROM AUTHOR]

Abstract: Background: The use of anticonvulsant drugs for the prevention of migraine in children and adolescents has been supported in the past. Aims: To evaluate the available evidence for the efficacy and safety of anticonvulsants drugs in the prevention of migraine attacks in children and adolescents. Methods: Studies were selected through a comprehensive literature search. We included all types of study designs (controlled and uncontrolled) due to the limited evidence. Monthly migraine frequency was used as the primary outcome measure in most of the studies. Studies were classified into levels of evidence according to their design. Results: Fourteen studies were included with a total of 939 patients. Topiramate (4 randomized controlled trials [RCT], two uncontrolled trials), sodium valproate/divalproex sodium (two RCTs, one uncontrolled trial, two retrospective chart reviews) levetiracetam and zonisamide (both only uncontrolled studies) are the anticonvulsants that have been reported in the literature. The findings show that valproate is not different from placebo and topiramate may not be different but further randomized trials are needed. All drugs were well tolerated in this age group with no serious events reported. Conclusions: The use of anticonvulsants in the prevention of migraine in children and adolescents is not adequately supported by methodologically sound RCTs. More research is needed in the future to establish the efficacy and safety of specific agents. [Copyright &y& Elsevier]

There is evidence that the prevalence of migraine in children and adolescents may be increasing. Current theories of migraine pathophysiology in adults suggest activation of central cortical and brainstem pathways in conjunction with the peripheral trigeminovascular system, which ultimately results in release of neuropeptides, facilitation of central pain pathways, neurogenic inflammation surrounding peripheral vessels, and vasodilatation. Although several risk factors for frequent episodic, chronic, and refractory migraine have been identified, the causes of migraine progression are not known. Migraine pathophysiology has not been fully evaluated in children. In this review, we will first discuss the evidence that early therapeutic interventions in the child or adolescent new onset migraineur, may halt or limit progression and disability. We will then review the evidence suggesting that many adults with chronic or refractory migraine developed their migraine as children or adolescents and may not have been treated adequately with migraine-specific therapy. Finally, we will show that early, appropriate and optimal treatment of migraine during childhood and adolescence may result in disease modification and prevent progression of this disease. [ABSTRACT FROM AUTHOR]

Here, we investigated the prevalence of headache among adults in Jordan. The study was conducted from January 2007 to November 2008. A sample of 4,836 participants were permitted to complete a self-conducted screening questionnaire. As much as 82.3% of participants complained from headache at least once per year. 36.1% were tension-type headache and 59% of the participants had other family members who suffered from headache. Headaches affected everyday activities in 51.6% of the participants; 82.7% of participants did not seek medical attention for their headaches. Among those who used analgesics (75.6%), acetaminophen was the most common (91.43%). In conclusion, headache and overuse of analgesics were prevalent in a significant part of the society. Thus, there is a need to educate the public to ensure safe practices and to make the use and selling of analgesics more stringent. [ABSTRACT FROM AUTHOR]

We employed a self-administered questionnaire to investigate exertional headache (EH) in students (ages 13–15 years) from two middle schools in Taiwan. In this study, the diagnosis of EH was made if the headache occurred during or immediately after exercise. In total, 1963 students completed the study (response rate 90.7%). The prevalence of EH was 30.4% ( n = 596), was higher in girls and decreased with age. EHs were commonly bilateral (51.4%), pulsating (59.4%) and short-lasting (≤ 1 h in 79%). Only 13.8% of the adolescents with EH took painkillers for the headache. Migraineurs were more likely to have EH than non-migraineurs (47.5% vs. 21.1%, P < 0.001) and their EH had more features of migraine and needed more frequent treatment with painkillers. Only 200 subjects (10.2%) fulfilled the International Classification of Headache Disorders, 2nd edn criteria for primary EH excluding criterion C. Our study disclosed that EH was quite prevalent in adolescents. Migraineurs were vulnerable to EH and had more disabling attacks. [ABSTRACT FROM AUTHOR]

Studies on the treatment of migraine in children and adolescents are rare and difficult to design. In particular, the high placebo response in some trials makes it difficult to prove efficacy of a verum drug. We analysed all available placebo-controlled trials on acute and on prophylactic migraine treatment in children and adolescents with respect to different placebo rates (pain free and pain relief at 2 h; rate of responders with ≥ 50% attack frequency decrease). We identified eight crossover and 11 parallel group trials on acute treatment. The placebo response rates were considerably lower in crossover trials than in parallel group trials (19.2% vs. 27.1% for pain free after 2 h and 39.4% vs. 56.9% for pain relief after 2 h). In the 10 prophylactic trials included in this analysis, only a small trend towards a lower placebo rate in crossover trials could be observed. Further significant factors associated with a lower placebo rate in childhood and adolescence trials on the acute treatment of migraine were single-centre (vs. multicentre) trials and small sample size. Age and sex were not associated with the placebo response. Our study suggests that parallel group trials on the acute treatment of migraine in children and adolescents show a very low therapeutic gain due to a high placebo rate. The verum response rates, however, are very similar to those seen in adulthood trials. In conclusion, trial designs on the acute and prophylactic treatment of migraine in children and adolescents should consider the specific findings of this analysis in order to exhibit a higher probability of showing significant differences between placebo and verum drug. [ABSTRACT FROM AUTHOR]

Objective.— To characterize menstrually associated headaches and migraine in adolescent girls and identify any developmental and pubertal changes. Background.— Headache and migraine is a common problem in adolescents with a transition to adult patterns. One pattern of adult migraine is the menstrual association in a significant number of women. Methods.— A retrospective analysis was performed of characteristics of adolescent's headaches including association with menstrual pattern. A detailed analysis of the patient- and parent-reported headache characteristics and patterns of longitudinal change with development and puberty was reviewed, including timing of headache with age and menstrual period and progression of these events over the adolescence. Results.— Of the 896 girls between 9 and 18 years old reviewed at initial evaluation, 331 (50.3% of menarchal girls and 36.9% of all girls) report experiencing headaches with their menstrual period. Of those reporting a menstrual pattern, 63.6% reported migraines starting between day −2 and +3 of their menstrual period start. Girls with menstrual migraine reported increased associated symptoms compared with girls without menstrual migraine. There was no difference in disability between girls with a menstrual pattern and those without a menstrual pattern ( t = 1.64; P = .10). Additionally, 160 girls reported a monthly pattern to their headaches prior to beginning menstruation, suggestive of a menstrually related migraine pattern prior to menstruation. Conclusions.— The pattern of menstrual association begins to become apparent during adolescence. Once the menstrual pattern has developed, this association is stable. Early identification of this pattern has potential long-term benefit for improved lifelong outcome. [ABSTRACT FROM AUTHOR]

Background.— Few studies in adolescents deal with the level of agreement between questionnaire and interview information in relation to headache symptoms. Objective.— To evaluate the validity of a self-administered questionnaire on headache for use in epidemiological studies of Italian high school students. Methods.— The questionnaire incorporated all items required for diagnosing migraine according to the criteria from the 2004 International Classification of Headache Disorders. The migraine diagnoses obtained from questionnaires were validated against the gold standard diagnoses by a headache specialist. Results.— Out of 104 students answering the questionnaires, 93 (89.4%) participated in extensive semi-structured interviews by a neurologist. The chance-corrected agreement rate (kappa) was 0.66, which is considered good. The questionnaire-based migraine diagnosis had a sensitivity of 67.3%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 73.3%. Conclusions.— The results indicate that our self-administered questionnaire may be an acceptable instrument in determining the prevalence of migraine sufferers in the northeast Italy adolescent population, useful in identifying subjects with “definite” migraine. [ABSTRACT FROM AUTHOR]

Psychological interventions for migraines typically include biofeedback training, stress-management training, or relaxation training and are implemented without consideration of environmental variables that might maintain migraines or complaints of migraines. An adolescent with daily reports of migraines that negatively impacted school attendance participated in therapy with his parents. A functional assessment of migraine complaints was conducted with the participant and his mother. After developing a hypothesis that the function of migraine complaints was escape from tasks and school, differential reinforcement and escape extinction were implemented. Results indicate that migraine reports can be successfully treated using a function-based intervention even when standard psychological interventions were ineffective, illustrating the importance of considering the function of a problem rather than treating based upon the topography. [ABSTRACT FROM AUTHOR]