Johnson Hannah F, Goadsby Peter J, Gelfand Amy A
Vanderbilt University School of Medicine, Nashville, Tennessee.
The Clinical Research Facility, Headache Center, Department of Neurology, University of California, San Francisco, California; The Clinical Research Facility, Headache Group, NIHR-Wellcome Trust Clinical Research Facility, King's College London, UK.
Pediatr Neurol. 2016 May;58:37-40. doi: 10.1016/j.pediatrneurol.2016.01.022. Epub 2016 Mar 8.
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.
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.
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).
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.
偏头痛在儿童和青少年中很常见，且可能导致功能障碍。能够根据临床表型预测哪些患者对曲坦类药物有反应会很有帮助。成人数据表明，头颅自主神经症状和先兆可预测曲坦类药物的反应。本研究调查了儿童偏头痛患者中曲坦类药物反应的临床预测因素。
这项图表回顾研究纳入了2014年在加利福尼亚大学旧金山分校头痛中心就诊的所有18岁以下偏头痛患者。进行单因素χ(2)分析，随后进行多因素逻辑回归建模。
127例儿童偏头痛患者中，70例（55%）患有慢性偏头痛，24例（19%）有先兆。大多数（55%）至少有一项头颅自主神经症状。在有曲坦类药物疗效数据的65例患者中，47例（73%）从曲坦类药物中获益。在单因素分析中，慢性偏头痛患者中65%从曲坦类药物中获益，而发作性偏头痛患者中这一比例为88%（P = 0.048）；有先兆患者中67%，无先兆患者中74%（P = 0.66）；有头颅自主神经症状患者中70%，无头颅自主神经症状患者中74%（P = 0.76）。在多因素逻辑回归模型中，慢性偏头痛、先兆和头颅自主神经症状并不是曲坦类药物获益的统计学显著预测因素：慢性偏头痛：0.25（0.06 - 1.04）；先兆：0.65（0.09 - 4.45）；头颅自主神经症状：0.75（0.22 - 2.52）。
在单因素分析中，慢性偏头痛患者从曲坦类药物中获益的可能性较小。与成人中记录的情况相反，头颅自主神经症状和先兆并不能预测曲坦类药物的反应，尽管我们的样本量较小限制了研究的效能。需要开展更大规模的儿童研究，未来儿童曲坦类药物试验应提供按先兆等临床变量分层的反应率。
