Prophylactic treatment of migraine in children. Part 1. A systematic review of non-pharmacological trials

The aim of this study was to assess the efficacy of non-pharmacological prophylactic treatments of migraine in children. Databases were searched from inception to June 2004 and references were checked. We selected controlled trials reporting the effects of non-pharmacological prophylactic treatments in children with migraine. We assessed trial quality using the Delphi list and extracted data. Analyses were carried out according to type of intervention. A total of 19 trials were included. Relaxation, relaxation + biofeedback, relaxation + biofeedback + cognitive behavioural treatment were more effective compared with waiting list controls. Relaxation + behavioural therapy was more effective than placebo. There is conflicting evidence for the use of oligoantigenic diets. A few non-pharmacological treatments such as relaxation may be effective as prophylactic treatment for migraine in children. Because of the small number of studies and the methodological shortcomings, conclusions on effectiveness have to be drawn with caution

Stress and tension-type headache mechanisms

Stress is widely demonstrated as a contributing factor in tension-type headache (TTH). The mechanisms underlying this remain unclear at present. Recent research indicates the importance of central pain processes in tension-type headache (TTH) pathophysiology. Concurrently, research with animals and healthy humans has begun to elucidate the relationship between stress and pain processing in the central nervous system, including central pain processes putatively dysfunctional in TTH. Combined, these two fields of research present new insights and hypotheses into possible mechanisms by which stress may contribute to TTH. To date, however, there has been no comprehensive review of this literature. The present paper provides such a review, which may be valuable in facilitating a broader understanding of the central mechanisms by which stress may contribute to TTH.Stuart Cathcart, Anthony H Winefield, Kurt Lushington and Paul Rola

Effectiviteit van interventies bij kinderen met migraine

Verhagen AP, Damen L, Bruijn JKJ, Berger MY, Passchier J, Koes BW. Effectiveness of interventions in children with migraine. Huisarts Wet 2006;49(3):123-9. Objective To assess the effectiveness and tolerance of treatment methods for episodes of migraine in children. Methods We performed a systematic review. Databases were searched from inception to June 2004, and references were checked. We selected randomised and controlled trials reporting the effects of symptomatic and prophylactic treatment methods in children with migraine, using headache features as outcome measure. Two independent reviewers assessed trial quality and extracted data. Quantitative and qualitative analyses were carried out according to type of intervention. Results A total of 49 trials (total 3296 patients) were included in this review, of which 16 studies (32.7%) were considered to be of high quality. Ten studies evaluated the effectiveness of acute medication. Compared to placebo, headache improved significantly for acetaminophen, ibuprofen, and nasal sumatriptan. No significant differences were found between acetaminophen and ibuprofen or nimesulide, and between oral sumatriptan, rizatriptan and dihydroergotamine compared to placebo. All medications were well tolerated, but significantly more adverse events were reported for nasal sumatriptan. Nineteen studies evaluated the effectiveness of non-pharmacological prophylactic treatments. When compared to waiting list control, headache improved significantly for relaxation, relaxation plus biofeedback, and relaxation plus biofeedback plus cognitive behavioural treatment. There is conflicting evidence regarding the use of oligoantigenic diets. Lastly, 20 studies evaluated the effectiveness of pharmacological prophylactic treatments. Compared to placebo, headache improved significantly for flunarizine medication. There is conflicting evidence for the use of propranolol. Nimodipine, clonidine, L-5HTP, trazodone and papaverine showed no efficacy when compared to placebo. Conclusions Acetaminophen and ibuprofen are effective symptomatic pharmacological treatments of episodes of migraine in children. Nasal spray sumatriptan is also effective, but more side effects are reported. A few treatments, such as relaxation and flunarizine, may be effective as prophylactic treatment for migraine in children