Peck Jacquelin, Zeien Justin, Patel Megha, Cornett Elyse M, Berger Amnon A, Hasoon Jamal, Kassem Hisham, Jung Jai Won, Ramírez Giovanni F, Fugueroa Paola Colon, Singhal Neil R, Song Jaehong, Kaye Adam M, Kaye Alan D, Koushik Sarang S, Strand Natalie H, Ganti Latha
Department of Anesthesiology Mount Sinai Medical Center.
Department of Anesthesiology University of Arizona College of Medicine-Phoenix.
Health Psychol Res. 2023 Jan 28;10(5):67853. doi: 10.52965/001c.67853. eCollection 2022.
This is a review of the latest and seminal evidence in pediatric migraine. It covers the etiology and pathophysiology known today, and then will review treatment options, efficacy and safety, quality of data and indications. Though migraine is usually regarded as an infliction in adults, it is not uncommon in the pediatric population and affects up to 8% of children. Children may experience migraine differently than adults, and present not only with headache but also frequent gastrointestinal symptoms. They are frequently shorter in duration than in adults. Traditional migraine treatment in adults is less effective in children. In this population, adjunct therapies - such as interventional techniques - should be considered when traditional treatment fails, including Botulinum Toxin A (BTA) injections, peripheral nerve and ganglion blocks. BTA injections are FDA approved for migraine prophylaxis in adults, but currently not in children; however, recent evidence shows efficacy and safety in pediatric migraine management. Nerve blocks stop nociceptive afferent fibers through injection of local anesthetics, and it may be associated with the local injection of corticosteroids. Although more common in adults, recent data suggests they are safe and effective in children and adolescents. Blocking the sphenopalatine ganglion can be achieved through nasal approach, and achieves a similar action by blocking the entire ganglion. Interventional techniques may provide a key component in the alleviation of this otherwise debilitating chronic migraine pain. Though most studies have been performed in adults, new studies provide encouraging results for treatment in children.
这是一篇关于儿童偏头痛最新及重要证据的综述。它涵盖了目前已知的病因和病理生理学，随后将回顾治疗选择、疗效与安全性、数据质量及适应证。尽管偏头痛通常被视为成年人的疾病，但在儿童群体中也并不罕见，影响着多达8%的儿童。儿童偏头痛的表现可能与成人不同，不仅会出现头痛，还常伴有胃肠道症状。其发作持续时间通常比成人短。成人的传统偏头痛治疗方法在儿童中效果较差。在这一群体中，当传统治疗无效时，应考虑采用辅助治疗，如介入技术，包括注射肉毒杆菌毒素A（BTA）、外周神经和神经节阻滞。BTA注射已获美国食品药品监督管理局（FDA）批准用于成人偏头痛的预防，但目前尚未批准用于儿童；然而，最近的证据表明其在儿童偏头痛治疗中具有疗效和安全性。神经阻滞通过注射局部麻醉剂来阻断伤害性传入纤维，可能还会局部注射皮质类固醇。尽管神经阻滞在成人中更为常见，但最近的数据表明它们在儿童和青少年中是安全有效的。通过鼻腔途径可实现蝶腭神经节阻滞，通过阻断整个神经节达到类似的效果。介入技术可能是缓解这种令人衰弱的慢性偏头痛疼痛的关键组成部分。尽管大多数研究是在成人中进行的，但新的研究为儿童治疗提供了令人鼓舞的结果。
