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Flunarizine for Headache Prophylaxis in Children With Sturge-Weber Syndrome
Felicity Gallop1, Tangunu Fosi2, Ponnudas Prabhakar1
1Neurosciences, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
Insights
Flunarizine effectively reduced headache severity, frequency, and duration in children with Sturge-Weber syndrome. This calcium antagonist showed promise for headache prophylaxis in this population with manageable side effects.
Area of Science:
- Neurology
- Pediatrics
- Pharmacology
Background:
- Sturge-Weber syndrome commonly causes severe headaches in children, sometimes with hemiparesis.
- Flunarizine, a calcium channel blocker, is a known treatment for migraines.
- The efficacy and safety of flunarizine for headaches in Sturge-Weber syndrome patients are not well-established.
Purpose of the Study:
- To evaluate the effectiveness of flunarizine in managing headaches in children with Sturge-Weber syndrome.
- To assess the adverse effects of flunarizine treatment in this pediatric population.
- To provide evidence supporting the specialist use of flunarizine for headache prophylaxis in Sturge-Weber syndrome.
Main Methods:
- A retrospective review of 20 children with Sturge-Weber syndrome treated with flunarizine for headaches.
- Data collected included headache severity, frequency, and duration before and during flunarizine treatment.
- Statistical analysis using the Wilcoxon signed rank test compared pre- and post-treatment outcomes.
Main Results:
- Flunarizine significantly decreased headache severity (P=0.001), monthly frequency (P=0.01), and duration (P=0.01).
- Treatment was discontinued due to adverse effects in only two patients.
- Common side effects included sedation and weight gain; no behavioral changes or extrapyramidal symptoms were reported.
Conclusions:
- Flunarizine demonstrated significant benefits in reducing headache burden in children with Sturge-Weber syndrome.
- The treatment was generally well-tolerated, with a low rate of discontinuation due to side effects.
- These findings support the off-label specialist use of flunarizine for headache prophylaxis in Sturge-Weber syndrome, despite its unlicensed status in some regions.
Background:
Children with Sturge-Weber syndrome can experience severe headache with or without transient hemiparesis. Flunarizine, a calcium antagonist, has been used for migraine. The experience with flunarizine for headache in a cohort of children at a national center for Sturge-Weber syndrome is reviewed, reporting its efficacy and adverse effect in this population.
Methods:
We collected data from health care professionals' documentation on headache (severity, frequency, duration) before and on flunarizine in 20 children with Sturge-Weber syndrome. Adverse effects reported during flunarizine treatment were collated. The Wilcoxon signed rank test was used to determine the significance of pre- versus post-treatment effect.
Results:
Flunarizine was used for headache alone (13) or mixed migrainous episodes and vascular events (7). The median duration of treatment was 145 days (range 43 to 1864 days). Flunarizine reduced headache severity (z = -3.354, P = 0.001), monthly frequency (z = -2.585, P = 0.01), and duration (z = -2.549, P = 0.01). Flunarizine was discontinued owing to intolerable adverse effects in a minority (2). Sedation and weight gain were the most common side effects. There were no reports of behavior change or extrapyramidal features.
Conclusions:
The most effective management for headaches in patients with Sturge-Weber syndrome has not been established. This retrospective observational study found benefit of flunarizine prophylaxis on headache severity, frequency, and duration in children with Sturge-Weber syndrome without severe side effects. Flunarizine is not licensed for use in the United Kingdom, but these data support its off-license specialist use for headache prophylaxis in Sturge-Weber syndrome.
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