Up to date on the use of triptans for child and adolescent migraine: “the state of the art”

The introduction of triptans, in the early 1990s, has improved the therapy for acute migraine attack, offering a new quality of life for those patients who suffer from this disabling neurological disorder. Epidemiological data point out that about 10% of school–age children suffer from migraine, with a progressive increase in incidence and prevalence up to the threshold of adulthood. The increase in extent and prevalence of migraine from the years of growth stresses the importance of the application and adjustment of ad hoc therapeutic (either pharmacological or not) and diagnostic measures. Indeed, the peculiar neurobiological and psychological aspects which are typical of an “evolving” organism preclude the use, by simple “transposition” or “proportion”, of the knowledge acquired from adult–targeted studies. That requires the implementation of studies to analyze the specific responses of children and adolescents to the triptans. To date, the studies on such issues are absolutely insufficient to draw definitive conclusions and indications for the use of triptans for child and adolescent migraineurs

The relationship between difficulties in emotion regulation and dysfunctional technology use among adolescents

Objectives Since two decades scientific research is studying excessive and dysfunctional new technologies use and its influences on people’s lives, in terms of personal, relational, scholastic and work functioning impairment. The objectives of the present study are to investigate gender differences in problematic new technologies use as well as to examine the relationship between problematic new technologies use, emotional regulation and its specific dimensions. Methods 280 italian adolescents (51.1% males) aged 11 to 18 years (mean age = 13.31; SD = 2.33) were recruited from two italian secondary public schools and involved in this study. Data were collected using the Internet Addiction Test, the Video Game Dependency Scale, the Brief Multicultural Version of the Test of Mobile-Phone Dependence and the Difficulties in Emotion Regulation Scale. Results Results indicate significant association between emotion dysregulation and problematic internet (r = .504; p < .001), videogame (r = .372; p < .001), mobile-phone (r = .424; p < .001) use. These results support hypothesis that adolescents with greater emotion dysregulation are more likely to experience problematic new technologies use. Additionally, stepwise multiple regression analysis pointed out that the lack of effective emotion regulation strategies is a common risk factors between the problematic new technologies use, but regression analysis highlighted specific risk factors for some of the investigated dependent behaviors. Conclusions Findings of this study highlight a link between problematic new technologies use, emotion dysregulation and its specific dimensions. The results are discussed considering scientific advances and the role of emotional dysregulation in determining problematic new technologies use in adolescence. Further research with larger sample sizes is needed to confirm our data

The effect of placebo and neurophysiological involvements

Placebo and placebo effect are important issues related to the drug therapy for clinical and scientific meanings. The rates of placebo may get as many as 50% for analgesic drugs in headache. The high answer to placebo brings questions on pathophysiology of headache. Answers may offer a new strategy in the implementation of trials and new insight in neurophysiology of headache. Current knowledge on placebo and placebo effect will be analysed and dicussed looking for new direction in headache field

Behavioral management of headache in children and adolescents

Headache is the most frequent neurological symptom and the most prevalent pain in children and adolescents, and constitutes a serious health problem that may lead to impairment in several areas. Psychosocial factors, social environment, life events, school and family stressors are all closely related to headaches. A multidisciplinary strategy is fundamental in addressing headache in children and adolescents. Applying such a strategy can lead to reductions in frequency and severity of the pain, improving significantly the quality of life of these children.It has been demonstrated that behavioral intervention is highly effective, especially in the treatment of paediatric headache, and can enhance or replace pharmacotherapy, with the advantage of eliminating dangerous side effects and or reducing costs. Behavioral interventions appear to maximize long-term therapeutic benefits and improve compliance with pharmacological treatment, which has proven a significant problem with child and adolescent with headache.The goal of this review is to examine the existing literature on behavioral therapies used to treat headache in children and adolescents, and so provide an up-to-date picture of what behavioral therapy is and what its effectiveness is

Headache disorders as risk factors for sleep disturbances in school aged children.

Several epidemiological studies have shown the presence of comorbidity between various types of sleep disorders and different headache subtypes. Migraine without aura is a sensitive risk factor for disorders of initiating and maintaining sleep (odds ratio (OR) 8.2500), and chronic tension-type headache for sleep breathing disorders (OR 15.231), but headache disorder is a cumulative risk factor for disorders of excessive somnolence (OR 15.061). This result has not been reported in the clinical literature. © Springer-Verlag Italia 2005

Alexithymia and psychopathological symptoms in adolescent outpatients and mothers suffering from migraines. A case control study

Background: Headache is a common disorder affecting a growing number of children and adolescents. In recent years, there has been an increase in scientific interest in exploring the relationship between migraine and emotional regulation, and in particular, the impact of emotional dysregulation on mental and physical health. The present study aims to explore the relationship between migraine and alexithymia among adolescents and their mothers as well as the impact of this association on mental health. An additional aim is to verify whether alexithymia may be a predictor of psychopathological symptoms in adolescents and mothers with migraines. Methods: A total of 212 subjects were involved in this study. The sample was divided into (a) Experimental Group (EG) consisting of 106 subjects (53 adolescents and 53 mothers) with a diagnosis of migraine according to International Classification of Headache Disorders (ICHD-3) and (b) Control Group (CG) including 106 subjects (53 adolescents and 53 mothers) without a diagnosis of migraine. All participants completed the Toronto Alexithymia Scale to assess alexithymia and the Symptom Checklist-90-R to assess psychopathological symptoms. Results: Higher rates of alexithymia were found in the adolescents and mothers of the EG in comparison to the adolescents and mothers of the CG. Furthermore, adolescents and mothers experiencing both migraine and alexithymia, demonstrated a higher risk of psychopathology. Conclusions: Findings from this study provide evidence that the co-occurrence of migraine and alexithymia increases the risk of psychopathology for both adolescents and their mother

Prenatal exposure to tobacco and alcohol are associated with chronic daily headaches at childhood: a population-based study

The influence of prenatal events on the development of headaches at childhood has not been investigated and is the scope of our study. Of 2,173 children identified as the target sample, consents and analyzable data were provided by 1,440 (77%). Parents responded to a standardized questionnaire with a validated headache module and specific questions about prenatal exposures. Odds of chronic daily headache (CDH) were significantly higher when maternal tabagism was reported. When active and passive smoking were reported, odds ratio (OR) of CDH were 2.29 [95% confidence intervals (CI)=1.6 vs. 3.6)]; for active tabagism, OR=4.2 (95% CI=2.1-8.5). Alcohol use more than doubled the chance of CDH (24% vs. 11%, OR=2.3, 95% CI=1.2-4.7). In multivariate analyses, adjustments did not substantially change the smoking/CDH association. Prenatal exposure to tobacco and alcohol are associated with increased rates of CDH onset in preadolescent children

Acceptability of the transitional wearable companion “+me” in typical children: a pilot study

This work presents the results of the first experimentation of +me-the first prototype of Transitional Wearable Companion–run on 15 typically developed (TD) children with ages between 8 and 34 months. +me is an interactive device that looks like a teddy bear that can be worn around the neck, has touch sensors, can emit appealing lights and sounds, and has input-output contingencies that can be regulated with a tablet via Bluetooth. The participants were engaged in social play activities involving both the device and an adult experimenter. +me was designed with the objective of exploiting its intrinsic allure as an attractive toy to stimulate social interactions (e.g., eye contact, turn taking, imitation, social smiles), an aspect potentially helpful in the therapy of Autism Spectrum Disorders (ASD) and other Pervasive Developmental Disorders (PDD). The main purpose of this preliminary study is to evaluate the general acceptability of the toy by TD children, observing the elicited behaviors in preparation for future experiments involving children with ASD and other PDD. First observations, based on video recording and scoring, show that +me stimulates good social engagement in TD children, especially when their age is higher than 24 months

The role of Attachment Insecurity in the emergency of anxiety symptoms in children and adolescent with migraine: an empirical study

Background: It is widely recognised that there are associations between headache, psychiatric comorbidity and attachment insecurity in both adults and children. The aims of this study were: 1) to compare perceived attachment security and anxiety in children and adolescents with migraine without aura and a healthy control group; 2) to test whether the child’s perceived security of attachment to the mother and the father mediated the association between migraine and anxiety. Methods: One hundred children and adolescents with Migraine without Aura were compared with a control group of 100 children without headache. The Security Scale (measures perceived security of attachments) and the Self-Administered Psychiatric Scales for Children and Adolescents, a measure of anxiety symptoms, were administered to all participants. Results: The clinical group had lower attachment security than the control group and higher scores on all anxiety scales. Anxiety was negatively correlated with attachment. Children’s attachment to their mother mediated the increase in global anxiety in the clinical group. Insecure paternal attachment was associated with greater insecurity in maternal attachment, suggesting that there is a complex pathway from migraine to anxiety symptoms mediated by perceived insecurity of paternal attachment and hence also by perceived insecurity of maternal attachment. Conclusion: These results suggest that insecure parental attachment may exacerbate anxiety in children and adolescents with migraine and point to the importance of multimodal interventions, perhaps taking account of family relationships, for children and adolescents with migraine