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Published on: June 2, 2014
Review of Interventional Therapies for Refractory Pediatric Migraine
Jacquelin Peck1, Justin Zeien2, Megha Patel2
1Department of Anesthesiology Mount Sinai Medical Center.
Insights
Pediatric migraine affects 8% of children, often presenting with gastrointestinal symptoms. Interventional techniques like Botulinum Toxin A and nerve blocks show promise for managing pediatric migraine when traditional treatments fail.
Area of Science:
- Neurology
- Pediatrics
- Pain Management
Background:
- Migraine is prevalent in children, affecting up to 8% of the pediatric population.
- Pediatric migraine can differ from adult presentations, including frequent gastrointestinal symptoms and shorter headache duration.
- Traditional adult migraine treatments are often less effective in children.
Purpose of the Study:
- To review current evidence on the etiology, pathophysiology, and treatment of pediatric migraine.
- To evaluate the efficacy and safety of various treatment options for migraine in children.
- To explore the role of interventional techniques in managing pediatric migraine.
Main Methods:
- Review of latest and seminal evidence in pediatric migraine.
- Analysis of treatment options, including efficacy, safety, data quality, and indications.
- Examination of adjunct therapies such as Botulinum Toxin A (BTA) injections, peripheral nerve blocks, and ganglion blocks.
Main Results:
- Botulinum Toxin A (BTA) injections demonstrate efficacy and safety in pediatric migraine management, despite lacking FDA approval for this age group.
- Peripheral nerve and ganglion blocks, including sphenopalatine ganglion blocks, are suggested to be safe and effective in children and adolescents.
- Interventional techniques offer a key component for alleviating chronic migraine pain in pediatric patients.
Conclusions:
- Interventional techniques like BTA injections and nerve blocks are valuable adjuncts for pediatric migraine management.
- Emerging evidence supports the safety and efficacy of these advanced treatments in children and adolescents.
- Further research is needed, but current data indicates promising results for interventional approaches in pediatric migraine.
Abstract:
This is a review of the latest and seminal evidence in pediatric migraine. It covers the etiology and pathophysiology known today, and then will review treatment options, efficacy and safety, quality of data and indications. Though migraine is usually regarded as an infliction in adults, it is not uncommon in the pediatric population and affects up to 8% of children. Children may experience migraine differently than adults, and present not only with headache but also frequent gastrointestinal symptoms. They are frequently shorter in duration than in adults. Traditional migraine treatment in adults is less effective in children. In this population, adjunct therapies - such as interventional techniques - should be considered when traditional treatment fails, including Botulinum Toxin A (BTA) injections, peripheral nerve and ganglion blocks. BTA injections are FDA approved for migraine prophylaxis in adults, but currently not in children; however, recent evidence shows efficacy and safety in pediatric migraine management. Nerve blocks stop nociceptive afferent fibers through injection of local anesthetics, and it may be associated with the local injection of corticosteroids. Although more common in adults, recent data suggests they are safe and effective in children and adolescents. Blocking the sphenopalatine ganglion can be achieved through nasal approach, and achieves a similar action by blocking the entire ganglion. Interventional techniques may provide a key component in the alleviation of this otherwise debilitating chronic migraine pain. Though most studies have been performed in adults, new studies provide encouraging results for treatment in children.
