ABSTRACT
Introduction: Headaches and migraine are common in the pediatric population, being one of the most frequent symptoms reported in practice. Additionally, it is a considerably disabling condition, which brings significant burden and impairs several aspects of a child or adolescent's life, such as mental and physical health, executive functioning, school performance. Children and adolescents with migraine have higher risk of psychiatric comorbidities and psychosocial adjustment difficulties, which, in turn, compromise even more patient's well functioning. Objective:The present article provides the clinician with a straightforward and evidence-based approach to migraine treatment in this age group. Comment: Treatment of migraine in children and adolescents requires a systematic and thorough approach. Clinicians should keep in mind the important burden migraine brings to a child's life, thus investigate, and properly manage comorbidities presented. Patient and parents' education is a meaningful part of the treatment. Moreover, non-pharmacological treatments, such as healthy lifestyle habits, behavioral interventions may also play beneficial roles. When preventive treatment is indicated, it should be tailored considering drug's profile of effectiveness and safety, as well as patient's comorbidities. Lack of evidence in this context must not translate in lack of action by the clinician, since there may be a relevant burden associated. Therefore, reasoning for the perspicacious clinician is of fundamental importance and may influence positively the outcomes.
Introdução: Dores de cabeça e enxaqueca são comuns na população pediátrica, sendo um dos sintomas mais frequentes relatados na prática. Além disso, é uma condição consideravelmente incapacitante, que traz sobrecarga significativa e prejudica diversos aspectos da vida de uma criança ou adolescente, como saúde mental e física, funcionamento executivo, desempenho escolar. Crianças e adolescentes com enxaqueca apresentam maior risco de comorbidades psiquiátricas e dificuldades de ajustamento psicossocial, o que, por sua vez, compromete ainda mais o bom funcionamento do paciente. Objetivo: O presente artigo fornece ao médico uma abordagem simples e baseada em evidências para o tratamento da enxaqueca nesta faixa etária. Comente: O tratamento da enxaqueca em crianças e adolescentes requer uma abordagem sistemática e minuciosa. Os médicos devem ter em mente o importante fardo que a enxaqueca traz à vida de uma criança, investigando e gerenciando adequadamente as comorbidades apresentadas. A educação do paciente e dos pais é uma parte significativa do tratamento. Além disso, os tratamentos não farmacológicos, como hábitos de vida saudáveis ââe intervenções comportamentais, também podem desempenhar papéis benéficos. Quando indicado tratamento preventivo, este deve ser adaptado considerando o perfil de efetividade e segurança do medicamento, bem como as comorbidades do paciente. A falta de evidências neste contexto não deve traduzir-se em falta de ação por parte do médico, uma vez que pode haver um ónus relevante associado. Portanto, o raciocínio do clínico perspicaz é de fundamental importância e pode influenciar positivamente os resultados.
ABSTRACT
PURPOSE: The aim of this study was to estimate the efficacy and safety of flunarizine in the treatment of pediatric headaches. METHODS: We conducted a retrospective analysis of clinical records of children aged between 4 and 19 years who were treated with flunarizine for headache at the Chosun university hospital between April 2006 and December 2012. Flunarizine was initially prescribed to patients 5 mg daily and was then escalated once in 7 patients because of the unresponsiveness to the initial dose. We evaluated the frequency, duration, severity, and disability of headache before and after the treatment of flunarizine. Effective treatment was defined as a reduction in the frequency of individual attacks by at the least 50%. RESULTS: Eighty five patients were identified, but 23 were excluded due to missing records. Sixty two children were included in the study: 18 boys and 44 girls with a mean age of 11 years. The diagnostic categories included migraine (27), tension type headache (7), others (28). The mean frequency of attack was 15.1+/-8.9 per month. Good outcome was observed 54.8% (34/62) in 1 month, 70.4% (38/54) in 3 month, and 80.8% (42/52) in 6 month. Adverse effects were seen in 15 (24.2%): worsening of headache (4), sedation (3), weight gain/increased appetite (2), dizziness (1), drowsiness (1) and others (4). Flunarizine was discontinued due to adverse effects in 6 patients, which includes worsening of headache (4), muscle ache (1), and tremor (1). In addition, it was discontinued due to lack of efficacy in seven patients. CONCLUSION: Flunarizine appears to be effective and safe in pediatric headache in our study. However, further studies are needed.