Acute Migraine in a Child

Childhood migraine differs from the adult version in some ways, and management also must be targeted specifically to the needs of children.

Investigation of the plasma copeptin level in cases with childhood migraine

Copeptin is a hypothalamic stress hormone that is synthesized in the hypothalamus together with Arginine-vasopressin and circulated from the neurohypophysis in equimolar amounts and can indicate the individual stress level. The aim of this study was to investigate the plasma copeptin level for childhood migraine headache. In this study, total oxidant status (TOS); total antioxidant status (TAS); oxidative stress index (OSI); and copeptin were measured in the plasma samples of 61 migraine patients and 60 matched healthy participants. The median plasma copeptin levels in the patients group and control group were 298.25 and 194.35 pg/mL, respectively. Copeptin levels were significantly higher in migraine patients than in the healthy control group. The specificity and sensitivity of copeptin for 249.5 pg/dL cut off value predicting diagnosis of migraine were 67% and 64%, respectively. In addition, TOS and OSI levels were found to be higher and TAS levels were significantly lower in patients with migraine than healthy controls. Plasma copeptin levels are thought to increase in cases of childhood migraine secondary to increased oxidative stress. In the diagnosis of childhood migraine cases, it can be used together with oxidative stress biomarkers such as TAS, TOS and OSI as a complementary parameter.

P29 The preventative management of migraine headaches in paediatrics

AimTo determine the optimal preventative treatment option for paediatric migraineDesignA retrospective method. A review of 100 paediatric patients who attended outpatient clinics and their clinical outcomes evaluated at day 0, and at their next outpatient appointment (which is approximately 3 months after their first review). Their treatment was analysed to determine if they have remained on their migraine prophylaxis or changed to a different option.SettingChildren outpatient setting in a District General Hospital.Participants100 paediatric patients aged below 18 years of age.InterventionPatients aged below 18 years of age who have a documented diagnosis of migraine. This excluded abdominal migraine.Main Outcome MeasuresTo identify: which classes of drugs are being used for migraine prophylaxis, if there is a drug being used in preference to other drugs, how many preventative treatment options are tried before a preventative treatment is successful, if appropriate dosing regimens are being used for preventative treatment options, the common side effects (if any) of the drugs used in the management of migraine prophylaxis and if a different class of drug is being used for children under 12 years of age and over 12 years of age.Main ResultsPropranolol, topiramate, pizotifen, amitriptyline and gabapentin were medication used as initial treatment for paediatric migraine prophylaxis. Pizotifen was the most commonly used medication (n=71) and had the overall highest positive response rate of 76%. Topiramate, pizotifen and amitriptyline were noted to have caused side effects and prevent the subjects from continuing that course of prophylactic treatment. Age is a clinical factor which can influence the decision to start therapy. With a child’s advancing age, the features of childhood migraine change and therefore different medication may respond to the changing condition. It is evident from this research, pizotifen is used for children under the age of 12 years. However the true reason behind this is unknown. This could be due to the medication licensing or the side effect profile. Further trials are needed to review the demanding consideration on migraine in children of different ages. The BNF-C gives dosing advice on three preventative treatments; pizotifen, topiramate and propranolol. There was overall good compliance with dosing as per the BNFC; 91% in the pizotifen group, 100% in the topiramate group and 82% compliance in the propranolol group. In the BNF-C, for amitriptyline and gabapentin there is no dosing advice for migraine prophylaxis. Therefore, there was no dosing regimens to compare to and achieved 0% compliance with the BNF-C.ConclusionThis research has found pizotifen to be first line treatment for the prevention of migraines. Numerous medication have been identified as potentially preventing migraine but these have either not progressed to fruition or failed to achieve the expected outcomes. Further medication studies are needed to examine their effectiveness for preventing paediatric migraine.ReferencesBarnes N. ( 2019) ‘Migraine Headache in Children’, British Medical Journal. Available at: https://bestpractice.bmj.com/topics/en-gb/678/evidence (Accessed February 2019)Bille BO. ( 1997) ‘A 40-year follow-up of children with migraine’. Cephalalgia 1997;17:488–91. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9209767 (Accessed January 2019)Brandes JL Saper JR, Diamond M, et al. (2004) ‘Topiramate for migraine prevention: A randomized controlled trial’. JAMA. 2004;291:965–973. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14982912 (Accessed January 2019)Forsythe WI, Gillies D, Sills MA. ( 1984) ‘Propranolol in the treatment of childhood migraine’, Developmental Medicine and Child Neurology Journal, 26: 737–41.