Related Experiment Videos
[Response to prophylactic treatment of benign headache in children]
C Garaizar1, J M Prats, E Zuazo
1Departamento de Pediatría, Hospital de Cruces, Barakaldo, Vizcaya, España.
Insights
Prophylactic treatment for childhood headaches is often ineffective. School achievement and seasonal factors, not just medication, influence headache improvement, with the placebo effect playing a significant role.
Area of Science:
- Pediatrics
- Neurology
- Clinical Pharmacology
Background:
- Childhood headaches are common but often do not require prophylactic treatment.
- Existing prophylactic treatments for childhood headaches can be unsatisfactory.
Purpose of the Study:
- To investigate drug and non-drug factors influencing therapeutic response in pediatric headache patients.
- To evaluate factors affecting treatment outcomes for migraine without aura, tension-type headaches, and mixed headache types.
Main Methods:
- A four-month randomized, open-label, placebo-controlled study.
- Inclusion criteria: >= 2 monthly migraine without aura attacks, >= 10 tension-type headaches, or both.
- Patients were randomized to receive flunarizine, piracetam, or placebo.
Main Results:
- 98 patients were studied; 33% dropped out, with school underachievers more frequent among dropouts.
- 27% of patients receiving placebo achieved total symptom remission.
- High school achievers were more frequently among those not remitting with placebo.
- 43% of patients experienced ongoing headaches, showing a seasonal pattern.
Conclusions:
- Prophylaxis is needed for less than half of high-frequency childhood headache sufferers.
- School achievement is a predictor of compliance and headache persistence.
- Short-term headache improvement is influenced by seasonal factors and the placebo effect.
Introduction:
Common childhood headaches seldom require prophylactic treatment which, nevertheless, is quite often unsatisfactory.
Objective:
To study drug and non-drug related factors that may influence the therapeutic response.
Material And Methods:
A four-month follow-up study of all patients attended during a year at the neuropediatric, outpatient hospital-based clinic, with > or = 2 monthly migraine without aura attacks, > or = 10 tension-type headaches, or both types of headaches. Patients were randomized to be treated on an open basis, placebo controlled, with flunarizine or piracetam. Headache frequency was evaluated according to treatment and patients' basal characteristics.
Results:
98 patients studied (56 migraine without aura, 24 tension-type headache, 18 mixed). 33% dropped out; they were school underachievers more frequently than those that completed the protocol. Of those completing the protocol and treated with placebo as the first choice of therapy, 27% reported total remission of symptomatology; those not remitting with placebo were high achievers at school significatively more frequently. At the end of the trial, 43% of the initially randomized patients still complained of headaches, regardless of treatment, showing a seasonal relationship.
Conclusions:
Prophylaxis of benign childhood headaches is needed in less than half of those reporting a high headache frequency; school achievement should be taken into consideration as another clue to compliance and headache persistence. On a short-term basis only the seasonal influence and the placebo effect can be held responsible for amelioration of symptomatology.