Frattale Ilaria, Ferilli Michela Ada Noris, Ursitti Fabiana, Sforza Giorgia, Monte Gabriele, Proietti Checchi Martina, Tarantino Samuela, Mazzone Luigi, Valeriani Massimiliano, Papetti Laura
Child Neurology and Psychiatry Unit, Department of Wellbeing of Mental and Neurological, Dental and Sensory Organ Health, Policlinico Tor Vergata Foundation Hospital, Rome, Italy.
Developmental Neurology, Bambino Gesù Children' s Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, Italy.
J Headache Pain. 2024 Apr 23;25(1):61. doi: 10.1186/s10194-024-01766-7.
Chronic migraine (CM) negatively impacts the quality of life of 2 to 4% of pediatric patients. In adults, CM is frequently linked to medication overuse headache (MOH), but there is a much lower prevalence of MOH in children. A suboptimal response to acute therapies may lead to their reduced use, thus preventing MOH development in children and adolescents. The frequency of patients with CM who do not respond to acute therapies was examined in the present study. We investigated whether the prevalence of MOH was different between responders and non-responders. We also examined whether patients receiving prophylactic therapy had an improved response to acute therapy. Finally, we investigated if there was a difference in the frequency of psychiatric comorbidities between responders and non-responders.
We retrospectively analysed clinical data of all chronic pediatric migraineurs under the age of 18 referred to the Headache Centre at Bambino Gesù Children Hospital in June 2021 and February 2023. ICHD3 criteria were used to diagnose CM and MOH. We collected demographic data, including the age at onset of migraine and the age of the CM course. At baseline and after 3 months of preventive treatment, we evaluated the response to acute medications. Neuropsychiatric comorbidities were referred by the children's parents during the first attendance evaluation.
Seventy patients with CM were assessed during the chosen period. Paracetamol was tried by 41 patients (58.5%), NSAIDs by 56 patients (80.0%), and triptans by 1 patient (1.4%). Fifty-one participants (73%) were non-responder to the abortive treatment. The presence of MOH was detected in 27.1% of the whole populations. Regarding our primary aim, MOH was diagnosed in 29% of non-responder patients and 22% of responders (p > 0.05). All patients received preventative treatment. After 3 months of preventive pharmacological therapy, 65.4% of patients who did not respond to acute medications achieved a response, while 34.6% of patients who were non-responder remain non-responder (p < 0.05). Prophylactic therapy was also effective in 69% of patients who responded to acute medication (p < 0.05). Psychiatric comorbidities were detected in 68.6% of patients, with no difference between responders and non-responders (72.2% vs. 67.3%; p = 0.05).
Despite the high prevalence of unresponsiveness to acute therapies in pediatric CM, it does not act as a protective factor for MOH. Moreover, responsiveness to acute drugs is improved by pharmacological preventive treatment and it is not affected by concomitant psychiatric comorbidities.
慢性偏头痛（CM）对2%至4%的儿科患者的生活质量产生负面影响。在成年人中，CM常与药物过度使用性头痛（MOH）相关，但儿童中MOH的患病率要低得多。急性治疗反应欠佳可能导致其使用减少，从而预防儿童和青少年发生MOH。本研究调查了对急性治疗无反应的CM患者的频率。我们调查了反应者和无反应者之间MOH的患病率是否不同。我们还检查了接受预防性治疗的患者对急性治疗的反应是否有所改善。最后，我们调查了反应者和无反应者之间精神疾病共病频率是否存在差异。
我们回顾性分析了2021年6月和2023年2月转诊至 Bambino Gesù儿童医院头痛中心的所有18岁以下慢性儿科偏头痛患者的临床数据。采用国际头痛疾病分类第三版（ICHD3）标准诊断CM和MOH。我们收集了人口统计学数据，包括偏头痛发病年龄和CM病程年龄。在基线和预防性治疗3个月后，我们评估了对急性药物的反应。儿童父母在首次就诊评估时提及了神经精神共病情况。
在选定期间评估了70例CM患者。41例患者（58.5%）尝试了对乙酰氨基酚，56例患者（80.0%）尝试了非甾体抗炎药，1例患者（1.4%）尝试了曲坦类药物。51名参与者（73%）对终止治疗无反应。在全部人群中，27.1%检测到存在MOH。关于我们的主要目的，29%的无反应患者和22%的反应者被诊断为MOH（p>0.05）。所有患者均接受了预防性治疗。经过3个月的预防性药物治疗后，65.4%对急性药物无反应的患者有了反应，而34.6%的无反应患者仍然无反应（p<0.05）。预防性治疗对69%对急性药物有反应的患者也有效（p<0.05）。68.6%的患者检测到有精神疾病共病，反应者和无反应者之间无差异（72.2%对67.3%；p=0.05）。
尽管儿科CM患者中对急性治疗无反应的患病率很高，但它并不是MOH的保护因素。此外，药物预防性治疗可改善对急性药物的反应，且不受伴发的精神疾病共病影响。
