Saito Yoshiaki, Yamanaka Gaku, Shimomura Hideki, Shiraishi Kazuhiro, Nakazawa Tomoyuki, Kato Fumihide, Shimizu-Motohashi Yuko, Sasaki Masayuki, Maegaki Yoshihiro
Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan.
Brain Dev. 2017 May;39(5):386-394. doi: 10.1016/j.braindev.2016.11.011. Epub 2016 Dec 18.
To provide insight into the wide spectrum of migraine during childhood to establish practical and comprehensive treatment strategies.
Although recent studies have confirmed the effect of anti-migraine agents in childhood headaches fulfilling the criteria of migraine without aura, there have been no studies regarding the efficacy of these drugs in childhood migraine without aura not filling the diagnostic criteria.
In total, 154 patients with a clinical diagnosis of migraine, with onset of repetitive headaches at the age of ⩽15years, were retrospectively included from clinics in seven tertiary medical centers.
Patients' diagnoses included migraine with aura (n=49), migraine without aura (n=65), clinical migraine without aura not fulfilling International Classification of Headache Disorders-3 beta criteria (suspected migraine without aura; n=38), and hemiplegic migraine (n=2). Abortive medicine was effective in 74 of 97 patients, and preventive medicine was effective in 61 of 84 patients. Drugs with high efficacy were acetaminophen and ibuprofen for abortive therapy and cyproheptadine, amitriptyline, and propranolol for preventive therapy. Psychosocial problems were less common, and abnormalities on electroencephalography were more common in the suspected migraine without aura group. Otherwise, clinical features and drug responsibility were comparable among the migraine with aura, migraine without aura, and suspected migraine without aura groups. Retrospectively, experts clinically diagnosed childhood migraine without aura when the headache met at least one of the three criteria B, C, and D in International Classification of Headache Disorders-3 beta in addition to A and E. Abortive and preventive medication including paroxetine (n=2) benefited 10 and 15 of the 33 patients with daily headache, respectively. Psychotherapy/counseling (n=4), treatment for orthostatic dysregulation (n=4), and elimination of stressors (n=3) markedly alleviated headache in this group.
Our results indicated that those with suspected migraine without aura not filling International Classification of Headache Disorders diagnostic criteria should be included in the treatment for migraine. Treatment should also be targeted to comorbid developmental disorders, orthostatic dysregulation, and psychosocial problems in patients with refractory daily headaches.
深入了解儿童偏头痛的广泛症状，以制定切实可行且全面的治疗策略。
尽管近期研究已证实抗偏头痛药物对符合无先兆偏头痛标准的儿童头痛有效，但对于这些药物在不符合诊断标准的儿童无先兆偏头痛中的疗效尚无研究。
从7家三级医疗中心的诊所中回顾性纳入了154例临床诊断为偏头痛、15岁及以下开始反复头痛的患者。
患者诊断包括有先兆偏头痛（n = 49）、无先兆偏头痛（n = 65）、不符合《国际头痛疾病分类》第3版β标准的临床无先兆偏头痛（疑似无先兆偏头痛；n = 38）和偏瘫性偏头痛（n = 2）。97例患者中有74例使用终止发作药物有效，84例患者中有61例使用预防性药物有效。高效药物在终止发作治疗中为对乙酰氨基酚和布洛芬，在预防性治疗中为赛庚啶、阿米替林和普萘洛尔。社会心理问题较少见，脑电图异常在疑似无先兆偏头痛组中更常见。否则，有先兆偏头痛、无先兆偏头痛和疑似无先兆偏头痛组的临床特征和药物反应具有可比性。回顾性分析发现，如果头痛除符合《国际头痛疾病分类》第3版β中的A和E标准外，还至少符合B、C和D标准中的一项，则专家临床诊断为儿童无先兆偏头痛。包括帕罗西汀（n = 2）在内的终止发作和预防性药物分别使33例每日头痛患者中的10例和15例受益。心理治疗/咨询（n = 4）、体位性调节障碍治疗（n = 4）和消除应激源（n = 3）使该组头痛明显缓解。
我们的结果表明，不符合《国际头痛疾病分类》诊断标准的疑似无先兆偏头痛患者应纳入偏头痛治疗。对于难治性每日头痛患者，治疗还应针对共病的发育障碍、体位性调节障碍和社会心理问题。
