Treatment of primary headaches in children: preliminary results of a multicentre Italian study

Introduction The are few data in the literature about the use of pharmacological and non-pharmacological therapies for primary headaches (migraine: M; tension-type headache: TTH) in children [1]. Materials and methods A retrospective study was conducted by twelve Juvenile Headache Centres; inclusion criteria: (1) diagnosis of primary headache (ICHD-II, 2004); (2) stable headache pattern ([6 months). Results Three hundred and twenty cases (163 M, 157 F) with mean age at interview of 11.1 ± 3.2 years (1–19 years). Headache types: M 71% (MO 62%, MA 6%, chronic M 3%), TTH 20% (ETTH 17%, CTTH 3%), and M + TTH 7%, other 2%. A) Symptomatic treatment used in 92% of cases (1 drug 57%, 2 drugs 26%, 3 drugs 9%); M 95% versus TTH 82% (p\0.0002); type of drug: paracetamol (P) (M 84%, TTH 73%), NSAIDs (M 46%, TTH 24%), triptans (T) (M 5%, TTH 0%); good–excellent efficacy 53%, good–excellent tolerability 86%. Prescriber: paediatrician (47%), child neuropsychiatry (41%), self-prescription (10%). (B) Prophylaxis therapy used in 46% of cases (1 drug 31%, 2 drugs 11%, 3 drugs 4%); M 53% versus CT 29% (p\0.01); type of drug: flunarizine (M 22% vs. TTH 2%, p\0.0002), pizotifen (M 7%, TTH 0%), propranolol (M 3%, TTH 0%), amitriptyline (M 1%, TTH 2%), anticonvulsants (M 7%, TTH 0%), supplements (M 25%, TTH 19%), melatonin (M 4%, TTH 6%); good–excellent efficacy 65%, good– excellent tolerability 80%. Prescriber: paediatrician (14%), child neuropsychiatrist (84%), no self-prescription. (C) Non-pharmacological treatments (N = 27, 8%): relaxation/biofeedback (30%), cognitive-behavioural therapy (22%), homeopathy (15%), treatment of malocclusion (15%), acupuncture (7%), psychotherapy (7%) and biofeedback (4%). (D) Rating more effective therapy: pharmacological symptomatic (57%) than prophylaxis combined with symptomatic (25%) or alone (16%); better tolerated therapy: pharmacological symptomatic (57%), than prophylaxis combined with symptomatic (22%) or alone (18%). Main expectations of the patient: effect on pain (62%), speed of action (30%) and lack of side effects (21%). Discussion and conclusions The study population consists predominantly of migraineurs (71%). The therapy most widely used was symptomatic (92%), especially P or NSAIDs, with limited use of T (E 5%) with good efficacy and tolerability. The prophylactic drugs most used were supplements (25%) and flunarizine (22%), while AEDs were rarely used (7%). The prophylaxis was ineffective in a third of migraineurs (28–34%), although often well tolerated (43–60%). The non-pharmacological therapy was not widely used (7%) and rarely preferred by patients (2–3%).