Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers

The first multicenter Italian study

Irene Toldo, Martina Rattin, Egle Perissinotto, Debora De Carlo, Barbara Bolzonella, Margherita Nosadini, Livia Nicoletta Rossi, Angelo Vecchio, Alessandro Simonati, Marco Carotenuto, Cinzia Scalas, Vittorio Sciruicchio, Vincenzo Raieli, Giovanni Mazzotta, Elisabetta Tozzi, Massimiliano Valeriani, Carlo Cianchetti, Umberto Balottin, Vincenzo Guidetti, Stefano Sartori & 1 others Pier Antonio Battistella

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalEuropean Journal of Paediatric Neurology
DOIs
Publication statusE-pub ahead of print - Dec 31 2016

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Tension-Type Headache
Multicenter Studies
Headache
Migraine Disorders
Pizotyline
Acetaminophen
Tryptamines
Anti-Inflammatory Agents
Pharmaceutical Preparations
Ibuprofen
Therapeutics
Flunarizine
Cyproheptadine
Relaxation Therapy
Migraine without Aura
Migraine with Aura
Amitriptyline
Cognitive Therapy
Acupuncture
Melatonin

Keywords

  • Journal Article

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Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers : The first multicenter Italian study. / Toldo, Irene; Rattin, Martina; Perissinotto, Egle; De Carlo, Debora; Bolzonella, Barbara; Nosadini, Margherita; Rossi, Livia Nicoletta; Vecchio, Angelo; Simonati, Alessandro; Carotenuto, Marco; Scalas, Cinzia; Sciruicchio, Vittorio; Raieli, Vincenzo; Mazzotta, Giovanni; Tozzi, Elisabetta; Valeriani, Massimiliano; Cianchetti, Carlo; Balottin, Umberto; Guidetti, Vincenzo; Sartori, Stefano; Battistella, Pier Antonio.

In: European Journal of Paediatric Neurology, 31.12.2016.

Research output: Contribution to journalArticle

Toldo, I, Rattin, M, Perissinotto, E, De Carlo, D, Bolzonella, B, Nosadini, M, Rossi, LN, Vecchio, A, Simonati, A, Carotenuto, M, Scalas, C, Sciruicchio, V, Raieli, V, Mazzotta, G, Tozzi, E, Valeriani, M, Cianchetti, C, Balottin, U, Guidetti, V, Sartori, S & Battistella, PA 2016, 'Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers: The first multicenter Italian study', European Journal of Paediatric Neurology. https://doi.org/10.1016/j.ejpn.2016.12.009
Toldo, Irene ; Rattin, Martina ; Perissinotto, Egle ; De Carlo, Debora ; Bolzonella, Barbara ; Nosadini, Margherita ; Rossi, Livia Nicoletta ; Vecchio, Angelo ; Simonati, Alessandro ; Carotenuto, Marco ; Scalas, Cinzia ; Sciruicchio, Vittorio ; Raieli, Vincenzo ; Mazzotta, Giovanni ; Tozzi, Elisabetta ; Valeriani, Massimiliano ; Cianchetti, Carlo ; Balottin, Umberto ; Guidetti, Vincenzo ; Sartori, Stefano ; Battistella, Pier Antonio. / Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers : The first multicenter Italian study. In: European Journal of Paediatric Neurology. 2016.
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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.",
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TY - JOUR

T1 - Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers

T2 - The first multicenter Italian study

AU - Toldo, Irene

AU - Rattin, Martina

AU - Perissinotto, Egle

AU - De Carlo, Debora

AU - Bolzonella, Barbara

AU - Nosadini, Margherita

AU - Rossi, Livia Nicoletta

AU - Vecchio, Angelo

AU - Simonati, Alessandro

AU - Carotenuto, Marco

AU - Scalas, Cinzia

AU - Sciruicchio, Vittorio

AU - Raieli, Vincenzo

AU - Mazzotta, Giovanni

AU - Tozzi, Elisabetta

AU - Valeriani, Massimiliano

AU - Cianchetti, Carlo

AU - Balottin, Umberto

AU - Guidetti, Vincenzo

AU - Sartori, Stefano

AU - Battistella, Pier Antonio

N1 - Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

PY - 2016/12/31

Y1 - 2016/12/31

N2 - 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.

AB - 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.

KW - Journal Article

U2 - 10.1016/j.ejpn.2016.12.009

DO - 10.1016/j.ejpn.2016.12.009

M3 - Article

JO - European Journal of Paediatric Neurology

JF - European Journal of Paediatric Neurology

SN - 1090-3798

ER -