Pharmacological treatment of primary headaches in children: a multicentre Italian study

Introduction In the literature there are few data about the use of pharmacological treatments (acute and prophylaxis) of primary headaches [migraine (M), tension-type headache (TTH)] in children [1]. Materials and methods Retrospective multicentre study conducted in 13 Juvenile Headache Centres; inclusion criteria: 1) diagnosis of primary headache (ICHD-II 2004); 2) stable headache pattern (>6 months). Results Seven hundred and thirty-two cases (349 m, 383 f), mean age: 12 years. Headache types: M 68%, TTH 21%, M+TTH 5%, other 4%. The statistical analysis, conducted on patients with M or TTH (n=659), considered: efficacy and safety of several drugs, any differences based on age, diagnosis and geographical distribution. Symptomatic treatment: 93% of children (M 95%, TTH 88%); type of drug: paracetamol (M 75%, TTH 75%), NSAIDs (M 51%, TTH 27%), triptans (M 6%, TTH 0%); good-excellent efficacy 72%, good-excellent tolerability 92%. Prophylaxis therapy: 52% of cases (M 45%, TTH 44%); type of drug: flunarizine (M 18%, TTH 2%), pizotifen (M 6%, TTH 0%), amitriptyline (M 3%, TTH 5%), anticonvulsants (M 7%, TTH 1%), supplements (M 31%, TTH 34%), melatonin (M 10%, TTH 10%); good-excellent efficacy 76%, good-excellent tolerability 85%. Discussion and conclusions In our study population M prevails (76%). Symptomatic therapy is frequently used (93%), more often in M than TTH, with good efficacy and tolerability for all drugs; it is ineffective only in 10% of cases (range 7-23%). The use of NSAIDs prevail in M than TTH; few M (6%) use triptans. Prophylaxis therapy, prescribed in about half of cases (both in M and TTH), is ineffective in 12% of cases, but is usually well tolerated; supplements (32%) and flunarizine (14%) prevail.