Diagnosi e Cura delle Cefalee-‐2009

Diagnosi e Cura delle Cefalee-­‐2009 TREATMENT OPTION
SYMPTOMATIC
PROPHYLACTIC
There is no
evidence that
medications
effective in adults
are safe and
effective in younger
patients
Treatment of migraine
“Placebo responders”
Treatment
Children
Prophylactic
16 – 55% (a)
14 – 34% (a)
Symptomatic
20 – 69% (b,)
6 – 44% (a)
a) 
Van der Kuy 2002
b) 
Ueberall 1999 – Winner 2000
Aaltonen 2000 – Visser 2004
Adults
Diagnosi e Cura delle Cefalee-­‐2009 Diagnosi e Cura delle Cefalee-­‐2009 ADVANCES IN ACUTE MIGRAINE
TREATMENT IN CHILDREN AND ADOLESCENTS
Diagnosi e Cura delle Cefalee-­‐2009   Two triptans are now FDA-­‐approved for pediatric use for acute migraine:   Almotriptan is approved in adolescents’ ages 12–17 years. The 2-­‐h pain relief rate was 71.8% for a 6.25mg dose, and 72.9% for the 12.5mg dose. (Linder 2008)   Rizatriptan was recently approved for 6–17 year olds. The 2-­‐h pain relief rate was 73–74%. The approved dosing is 5mg in those less than 40 kg, and 10mg for those at least 40 kg . (Ahonen 2006) Diagnosi e Cura delle Cefalee-­‐2009 Diagnosi e Cura delle Cefalee-­‐2009 SUMATRIPTAN + NAPROXEN
Diagnosi e Cura delle Cefalee-­‐2009 EMERGENCY ROOM SETTING
Diagnosi e Cura delle Cefalee-­‐2009 EMERGENCY ROOM SETTING
Diagnosi e Cura delle Cefalee-­‐2009 No OPIOIDS!
TREATMENTS
SYMPTOMATIC
PROPHYLACTIC
Diagnosi e Cura delle Cefalee-­‐2009 1. 
2. 
3. 
4. 
5. 
frequency is ≥ 4/month
attacks duration is ≥ 4 hours
pain is moderate-severe
ineffective symptomatic drugs
symptomatic drugs’ side effects
TREATMENT
OPTIONS
PHARMACHOLOGICAL
NON
PHARMACHOLOGICAL
Diagnosi e Cura delle Cefalee-­‐2009 are effective and should be considered in
children and adolescents
are effective and should be considered in
adolescents (Riza also in children >6yrs)
insufficient data are currently available to
recommend their use both in children and
adolescents
Prophylactic drug treatment
probably effective efficacy data are conflicting
insufficient evidence to
make any
recommendations
Tension-type headache pharmacologic treatment in
childhood and adolescents is completely unexplored
Conclusions
There is a clear and urgent need
for controlled, randomized
and masked trials
≠
The complexity of headache
(biological, psychological and environmental factors)
Socrate was used to say his friend Carmide, suffering from recurrent headache: “Do not permit somebody to take care of your head without offering you the opportunity to dress your soul by means of delicate and profound conversations” Platone “I dialoghi dell’amore”