First Department of Pediatrics, School of Medicine, "Aghia Sofia" Children's Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Department of Neurology, Tallaght University Hospital, D24 NR0A Dublin, Ireland.
Toxins (Basel). 2024 Jun 28;16(7):295. doi: 10.3390/toxins16070295.
Migraine is a leading cause of disability worldwide, yet it remains underrecognized and undertreated, especially in the pediatric and adolescent population. Chronic migraine occurs approximately in 1% of children and adolescents requiring preventive treatment. Topiramate is the only FDA-approved preventative treatment for children older than 12 years of age, but there is conflicting evidence regarding its efficacy. OnabotulinumtoxinA is a known and approved treatment for the management of chronic migraine in people older than 18 years. Several studies examine its role in the pediatric population with positive results; however, the clear-cut benefit is still unclear. OnabotulinumtoxinA seems not only to improve disability scores (PedMIDAS) but also to improve the quality, characteristics, and frequency of migraines in the said population. This systematic review aims to summarize the evidence on the efficacy, dosing, administration, long-term outcomes, and safety of onabotulinumtoxinA in pediatric and adolescent migraine. Eighteen studies met the eligibility criteria and were included in this review. The mean monthly migraine days (MMDs), decreased from of 21.2 days per month to 10.7 after treatment. The reported treatment-related adverse effects were mild and primarily injection site related and ranged from 0% to 47.0%. Thus, this review provides compelling evidence suggesting that OnabotulinumtoxinA may represent a safe and effective preventive treatment option for pediatric migraine.
偏头痛是全球范围内导致残疾的主要原因，但它仍然未被充分认识和治疗，尤其是在儿科和青少年人群中。慢性偏头痛在儿童和青少年中的发生率约为 1%，需要预防治疗。托吡酯是唯一获得 FDA 批准用于治疗 12 岁以上儿童的预防药物，但关于其疗效存在相互矛盾的证据。肉毒毒素 A 是一种已知的、批准用于治疗 18 岁以上人群慢性偏头痛的药物。一些研究表明其在儿科人群中的作用具有积极的结果；然而，明确的益处仍不清楚。肉毒毒素 A 似乎不仅可以改善残疾评分（PedMIDAS），还可以改善该人群偏头痛的质量、特征和频率。本系统评价旨在总结关于肉毒毒素 A 在儿科和青少年偏头痛中的疗效、剂量、给药、长期结果和安全性的证据。有 18 项研究符合入选标准并被纳入本综述。治疗后每月偏头痛天数（MMD）从 21.2 天降至 10.7 天。报告的治疗相关不良事件是轻微的，主要与注射部位有关，范围从 0%到 47.0%。因此，本综述提供了有力的证据表明，肉毒毒素 A 可能是治疗儿科偏头痛的一种安全有效的预防治疗选择。
