Migraines in children from toddlers to teens

This article discusses migraine headaches and how they present in children from toddlers to teenagers.

A toddler is having bouts of projectile vomiting, quite frequently but not every day. Fearing something is "terribly wrong" with her daughter's digestive system, her mother takes her to the doctor. Within 20 minutes, the pediatrician has traced the girl's symptoms to motion sickness – she gets sick every time she rides in the car, or shortly after. Although she's never had a headache, by age 3 the girl is diagnosed with the neurological disorder called migraine.

What Is Migraine?

A simple definition is a “recurrent, episodic headache, or head pain, that typically lasts between two and 72 hours untreated,” says Andrew Hershey, chair and a professor of neurology at Cincinnati Children's Hospital Medical Center​​​​. For some people,​ migraine comes with nausea or vomiting, while others experience light and sound sensitivity. Headaches are usually throbbing and partial​​ (involving one side of the head) and moderately or severely intense.​ Migraine has a strong genetic component.

Hershey, director of the CCHMC Headache Center, says while most migraine episodes come and go, they can evolve into chronic migraine: “About a third of our patients get to the point that the headache just never leaves them.”

At least 10 percent of kids have migraine, Hershey says.​ While the rate is about 4 percent in preschoolers, by late teens it affects up to 15 percent of boys and 20 to 25 percent of girls. The youngest patient Hershey ever treated started at 10 months old.

What Triggers Migraine​?

“Migraine is more than a headache. It’s a generalized disturbance of function that involves brain and body,” says Joel Saper,​ a neurologist and director of the Michigan Head Pain and Neurological Institute in Ann Arbor.

Although many people believe stress "causes" migraine, researchers are still working to determine the complex causes for the condition. What's known is that children have a variety of migraine triggers that can set off an episode, including food sensitivities, fatigue, bright lights, loud noises and sleep changes.​

In younger kids, non-headache signs or “migraine equivalents” can include stomach pain, episodes of dizziness, vertigo (spinning), visual disturbances and sudden mood changes, Saper says. Motion sickness is migraine equivalent, he notes, and it’s been recently established that colic in babies is a forerunner to migraine.

Before starting any kind of treatment, it’s crucial to pin down the diagnosis. Some 300 other medical conditions cause headache in kids, Saper says. Emotional causes also have to be ruled out – like school avoidance in a kid who’s anxious or being bullied.

For parents, Saper says it’s key to find a knowledgeable health care provider, whether it’s a specialist, family practice doctor, nurse practitioner or physician assistant.

Life With Migraine for Kids

Two decades ago, Cathy Glaser ​was concerned about her 3-year-old daughter Samantha, who was having cyclical bouts of vomiting and upset stomach. Through careful questioning, the pediatrician traced the episodes to motion sickness.

Glaser knows a lot about migraine. “We like to say my daughter was doomed since both parents have migraine. It runs through both of our families,” says Glaser, who eventually started the Migraine Research Foundation in New York.

Although Samantha was stoic, Glaser could always tell when she had a migraine coming on. “I could look into my daughter’s eyes and see she was getting a headache,” she says. “I could look at her face – she was ashen. All of a sudden those sparkly child’s eyes were absolutely dead. And her whole affect changed.”

Migraine invaded every aspect of Samantha’s childhood, and she visited the emergency room several times a year. It hijacked family trips. On their way to a family reunion at Hersheypark in Pennsylvania, they were forced to pull off the New Jersey Turnpike, because Samantha was green with motion sickness.

School presents many challenges for kids with migraine. Glaser says that as a parent, you need to be your child’s advocate. And you have to be proactive.

“I used to go to school every year at the beginning, or before, with a doctor’s note about migraine and my own daughter’s treatment explain when she raises her hand and says, ‘I need to take my medication now,’ they need to let her go,” she recalls.

Samantha “didn’t want to miss her life,” Glaser says. Even as an 8-year-old, she would say “Mom, I can be alone and feeling horrible, or I can be at school with my friends feeling horrible. I choose school.”

Every summer Samantha's parents sent her off to sleep-away camps, ​and every time they got calls in the middle of the night to come get her – the camp couldn’t handle it. “This is the life of a child who has regular headaches who insists on living the life of a kid,” Glaser says.

Sameness Helps

Boys and girls get headaches equally until age 12 or 13 – but when girls start their periods, the picture changes. Migraine is an “estrogen-vulnerable” disorder, Saper explains. Hormone cycling in girls and later women – from menstruation, oral contraceptives and menopause – can make migraines worse. Boys are more likely to grow out of migraines than girls.

As she entered her teens, Samantha developed menstrual migraine. (She also gets weather headaches, when there’s a change in barometric pressure or a storm’s coming on.)

With migraine, “Sameness helps,” Saper says. Sleep is a big issue, and regular bedtimes and waking times are important. If kids have trouble sleeping, he says melatonin “is a particularly good medicine” to help.

Some children with migraine are food sensitive. “What they eat may make a difference, whether it be the gluten, cheese or dairy products – there’s a long list,” Saper says. Kids shouldn’t miss meals or skip breakfast.

Dehydration can also trigger migraines, and healthy habits include drinking plenty of water or other non-caffeine drinks. Exercise also helps, and so do relaxation and stress-management techniques. 

Not Your Parents’ Headache

For migraine that goes beyond a headache or two a month, research suggests the best approach combines medication and cognitive behavioral therapy. The two main drug categories are medications for treatment and for prevention.

NSAIDs such as Aleve and Ibuprofen are used to break acute headaches in kids, Hersey says ­– aspirin should be avoided because of the risk of liver problems. And parents and patients should be alert to overuse. For prevention, the drugs amitriptyline and topiramate are most commonly prescribed.

At Cincinnati Children’s Headache Center, after kids undergo a neurological and headache exam, the team comes up with a multipronged treatment plan, including medication choices and learning healthy habits. Kids with chronic headaches return for cognitive behavioral therapy, which takes about six weeks to absorb.

Part of the goal is getting kids to accept that they have a chronic illness and teaching them to manage their own care, Hershey says: “We often say to the kids, ‘It’s your headache – it’s not your mom and dad’s.”

Scott Powers, a pediatric psychologist at the center, is working with his team to fine-tune a migraine app that kids can use to track their episodes and symptoms electronically. The app also allows researchers to better connect the dots between triggers and headache timing.

College and Migraines

With the importance of regular sleep, healthy eating habits and keeping stress on an even keel – what could possibly go wrong when kids with migraine leave for college?

But when the time came, Samantha insisted on going away to a big school, Glaser says. After much discussion they agreed that Samantha would go to a school within driving distance, near a hospital and with a well-staffed campus health center.

“Her view about college was ‘I want to stop being 'Migraine Girl,'" Glaser recalls her daughter saying. “’I want to stop being defined by my disease.’” 

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Headaches in children

This article discusses headaches in children, which is becoming more prevalent as the school year begins.

As the school year approaches and begins, many parents may start to hear their children complain about headaches.

According to Nick DeBlasio, MD, a pediatrician in Cincinnati Children's Hospital Medical Center's Pediatric Primary Care Clinic, about 10% of school-aged children and 15-27% of teens experience them from time to time.

Headaches can be triggered by a number of different things. Here are the most common causes of occasional headaches in children:

Inadequate hydration. Not drinking enough fluids is one of the biggest causes of headaches. This is especially true when the weather gets warmer and kids become more active outside and lose fluid through sweating. If this is the case, the cure might be as simple as having your child drink more water.

Diet. Does your child eat regular meals? Skipping one meal, like breakfast, can trigger a headache. It's also important to make sure that your child is eating a well-balanced diet with lots of fruits and vegetables. Too much caffeine and certain foods can cause a headache as well.

Sleep. Kids in middle and high school typically need at least 10-12 hours of sleep a night. Not sleeping enough at night can cause a headache. And getting less than 10 hours isn't enough to feel well-rested.

Stress. We all experience stress from time to time, and children and teens are no exception. If your child is under a lot of pressure from school, or experiencing big changes at home like a divorce or a big move, a headache can result.

Vision problems. If your child is unable to see what's happening at the front of the classroom, he might be straining his eyes to see far away, which can result in a headache. A vision test can give you a better understanding of whether or not your child's headaches are being caused by vision problems.

Family history. Your child is more likely to have headaches if a parent gets them as well.

If your child has a headache, try giving her water and over-the-counter ibuprofen. Follow the instructions on the package for the appropriate dosage and do not give it to your child more than three times in a week. If it persists for a few days or worsens, call your child's pediatrician.

Fortunately the majority of headaches in children are not a cause for alarm. However, there are a few instances which require a little more investigation. If your child's headaches have become more frequent or severe, if he wakes up in the morning of the middle of the night from it, or if the headache causes vomiting, it's best to have your child evaluated by your pediatrician.

He or she will perform a physical exam and decide if any tests need to be done. Brain MRIs and CT scans are rarely needed. If your pediatrician suspects a migraine, she might refer your child to a neurologist who is familiar with medications to help prevent and treat them.

And if your child or teen is suffering from chronic headaches and migraines, recent research by Cincinnati Children's found that adding cognitive behavioral therapy to treatment of pediatric migraines improves relief.

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Headaches in children

This article gives a lot of information on headaches in children.

Why do children get headaches?

Headaches in children are common and usually not serious.  Causes include migraines, stress and tension headaches, trauma, sinus disease and eye problems.  Certain foods with nitrate preservatives and MSG (monosodium glutamate) can trigger headaches.  Brain tumors in children as a cause for headaches are extremely rare, and are usually associated with additional neurologic symptoms such as dizziness and lack of coordination.

How are children with headaches evaluated?

Children should have a thorough physical examination with a pediatrician.  He/she may order additional tests or refer to a neurologist.  It is helpful to keep a headache diary so that possible triggers (certain foods or activities) can be discovered.

If no obvious medical cause for the headaches is found by the pediatrician, a referral to an ophthalmologist is required to perform a complete eye exam.  The entire visual system should be examined.  This includes refractive error (the need for glasses), eye alignment, and binocularity (the ability to use both eyes together).  During this examination the pupils should be dilated.

 How do eye problems cause headaches in children?

Hyperopia (farsightedness) requires extra effort to focus clearly while reading.  This can sometimes lead to fatigue and headache.  Glasses can reduce the effort required to see clearly at near and improve the headache.

The decreased ability to pull the eyes toward each other when viewing near objects (convergence), particularly while reading, may cause headaches.  This is called convergence insufficiency, and symptoms include the doubling of images or words, blurred vision, fatigue, and headaches which worsen with prolonged reading.  Glasses are sometimes prescribed.  At home eye exercises, sometimes with the help of computer software, can help treat convergence insufficiency.  Expensive in office eye exercises are rarely indicated.

 Acute infections and inflammatory diseases of the eyes can cause headaches.  These problems are often accompanied by redness of the eye and/or eyelid and light sensitivity (photophobia).  Acute glaucoma can cause headaches, but rarely affects children.  A complete exam by an ophthalmologist can rule out these conditions.

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Headaches and migraines in teens can be caused by chewing gum

Headaches and migraines in teenagers could be caused by or worsened by frequently chewing gum due to the joint between the jaw and the skull.

Teenagers are notorious for chewing a lot of gum. The lip smacking, bubble popping, discarded gum stuck to the sole give teachers and parents a headache.

Now, Dr. Nathan Watemberg of Tel Aviv University-affiliated Meir Medical Center has found that gum-chewing teenagers, and younger children as well, are giving themselves headaches too. His findings, published in Pediatric Neurology, could help treat countless cases of migraine and tension headaches in adolescents without the need for additional testing or medication.

"Out of our 30 patients, 26 reported significant improvement, and 19 had complete headache resolution," said Dr. Watemberg. "Twenty of the improved patients later agreed to go back to chewing gum, and all of them reported an immediate relapse of symptoms."

Right under our noses

Headaches are common in childhood and become more common and frequent during adolescence, particularly among girls. Typical triggers are stress, tiredness, lack of sleep, heat, video games, noise, sunlight, smoking, missed meals, and menstruation. But until now there has been little medical research on the relationship between gum chewing and headaches.

At Meir Medical Center's Child Neurology Unit and Child Development Center and community clinics, Dr. Watemberg noticed that many patients who reported headaches were daily gum chewers. Teenage girl patients were particularly avid chewers -- a finding supported by previous dental studies. Dr. Watemberg found that in many cases, when patients stopped chewing gum at his suggestion, they got substantially better.

Taking a more statistical approach, Dr. Watemberg asked 30 patients between six and 19 years old who had chronic migraine or tension headaches and chewed gum daily to quit chewing gum for one month. They had chewed gum for at least an hour up to more than six hours per day. After a month without gum, 19 of the 30 patients reported that their headaches went away entirely and seven reported a decrease in the frequency and intensity of headaches. To test the results, 26 of them agreed to resume gum chewing for two weeks. All of them reported a return of their symptoms within days.

Two previous studies linked gum chewing to headaches, but offered different explanations. One study suggested that gum chewing causes stress to the temporomandibular joint, or TMJ, the place where the jaw meets the skull. The other study blamed aspartame, the artificial sweetener used in most popular chewing gums. TMJ dysfunction has been shown to cause headaches, while the evidence is mixed on aspartame.

Gumming up the works

Dr. Watemberg favors the TMJ explanation. Gum is only flavorful for a short period of time, suggesting it does not contain much aspartame, he says. If aspartame caused headaches, he reasons, there would be a lot more headaches from diet drinks and artificially sweetened products. On the other hand, people chew gum well after the taste is gone, putting a significant burden on the TMJ, which is already the most used joint in the body, he says.

"Every doctor knows that overuse of the TMJ will cause headaches," said Dr. Watemberg. "I believe this is what's happening when children and teenagers chew gum excessively."

Dr. Watemberg says his findings can be put to use immediately. By advising teenagers with chronic headaches to simply stop chewing gum, doctors can provide many of them with quick and effective treatment, without the need for expensive diagnostic tests or medications.

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Childhood migraines

This article discusses migraines in children and the differences between them and adult migraines.

Headaches are a common complaint throughout childhood, but pediatricians have recognized that children have many different types of headaches, including migraines. Migraine headaches are best diagnosed by obtaining a detailed medical history and then conducting a thorough neurological exam.

Several characteristics of childhood migraines are quite different from those associated with adult migraines. While adult females have a higher incidence of migraine headaches, males predominate in the childhood population.

Childhood migraines often are shorter in duration than adult migraines and are less often unilateral (one-sided) than in adults. Only 25 percent to 60 percent of children will describe a unilateral headache, while 75 percent to 90 percent of adults have unilateral pain.

Children suffered from migraines don't typically have visual auras like adults, but may have a behavioral change with irritability, pallor, malaise, or loss of appetite proceeding the headache. Only about 18 percent of children describe migraine with an aura and another 13 percent may have migraines with and without auras at different times.

When taking a history, it's also important to ask about any family history of migraines, as these headaches seem to run in families. Children who develop migraines were often "fussy" infants, and they also have an increased incidence of sleep disorders, including night terrors and nightmares. Many parents and children who get migraines also report a history of motion sickness.

When children discuss their headaches, they often complain of feeling dizzy (although, after further questioning, this actually sounds more like being lightheaded than suffering from vertigo). They may also complain of blurred vision, abdominal pain, nausea and vomiting, chills, sweating, or even feeling feverish. Children with migraines appear ill, uncomfortable and pale, and will often have dark circles around their eyes.

It seems that migraine headaches in childhood may be precipitated by hunger, lack of sleep, and stress. Keep in mind that "stress" for a child may be positive, such as being excited, as well as negative.

Children with migraines will also tell you their headaches are aggravated by physical activity (including going up and down stairs, carrying a backpack, or even just bending over). Many complain of photophobia (light sensitivity) and phonophobia (sensitive to noises) and typically a parent will report that their child goes to bed in a dark room or goes to sleep when experiencing these symptoms.

Children with migraines don't watch TV or play video games during their headaches. They are quiet, may not want to eat, and may just want to rest. Nothing active typically "sounds" like fun to them.

To meet the diagnostic criteria for childhood migraine, a child needs to have at least five such "attacks." A headache log is useful, as these headaches may occur randomly and it's difficult to remember what each headache was like, or how long it lasted, without keeping a log.

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Treating migraines in children

This article discusses how common migraine headaches are in children and discusses the many possible causes for them.

Migraine headaches are actually common in childhood and adolescence. It’s estimated that about 5 percent of children have migraine headaches. There is evidence that migraines are genetic disorder, occurring in families.

Migraines may occur as a result of changes in blood vessel diameter. Constriction or spasm of blood vessels to the brain and surrounding structures may decrease blood flow to these areas. Researchers believe that migraines are due to inflammation of the nervous system involving serotonin receptors (serotonin is a particular kind of neurotransmitter in the brain) . This can result in a severe headache, as well as other neurological symptoms such as visual changes, difficulty speaking, weakness or numbness in one part of the body, tingling sensations, and others.

Other symptoms can include nausea, vomiting, abdominal pain, and a sensitivity to light (photophobia). Toddlers and infants can have symptoms such as cyclical vomiting (sometimes called abdominal migraine) and torticollis (spasm of the neck muscles resulting in head tilt).

Several factors can trigger migraines, including: food, caffeine, sun, stress, menses, oral contraceptives, fatigue or stress.

There are several types of migraine. The classic type is preceded by auras (seeing rainbows/halos around lights or flashing lights), followed by headache pain, which can take up to 60 minutes to begin. The common type migraine, most prevalent in children, is not preceded by auras.

Most children who get migraines will appear to be in normal health during a physical examination. However, it’s important that they are examined in order to rule out other causes of headache.

One of the simplest things I do is to examine patients’ eyes. Oftentimes children complaining of headaches have vision problems and need prescription lenses. I also examine the mouth carefully to make sure that my patients do not have dental abcesses causing pain. Additionally, sinus infection can cause headaches in children as well as adults.

The two most serious causes of headache that a health care provider should rule out are meningitis or brain lesions (tumors).

Meningitis involves symptoms such as fever and neck stiffness along with a headache.

A brain tumor would involve symptoms such as morning headaches that improve throughout the day as well as weakness, double vision, difficulty walking and personality changes.

Children with complicated migraines (marked by neurological symptoms that persist after termination of the headache) may need special brain imaging (called a MRI or magnetic resonance imaging) to rule out brain abnormalities.

There are several things that can be done to prevent migraines and treat migraine pain: First it’s often helpful to create a “headache diary.”

The parent or older child can make note of the timing of the headache, what the child was doing at the time the headache struck, whether there were certain foods eaten or medications being taken.

I also suggest that parents eliminate or minimize certain headache triggers. Some foods, especially nitrite-containing foods (including hot dogs, bologna, luncheon meats), aged cheeses, chocolate and caffeinated beverages (including tea, coffee and many sodas) which can all trigger migraines. I encourage families to limit (preferably eliminate) these items. Sun is also an important trigger. I recommend that children who experience migraines regularly wear sunglasses outside and sit in parts of the class room with the least sun glare. Some patients may get relief by taking a nap in a dark room.

There are several medications that can be used to treat migraines. Acetaminophen and ibuprofen can be effective for many children. Aspirin and aspirin-containing medications (such as Excedrin) should be avoided in children under 14 years of age due to the risk of developing Reyes Syndrome (a life threatening liver condition).

There are also medications used to prevent migraines, including propranolol, some antihistamines and tricyclic antidepressants. Some children also are given anti-nausea medications if they have severe nausea or vomiting with their migraines. There are other medications for migraine, however, they have not been extensively studied in children.

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Causes of headaches in children

This article discusses the many possible causes of headaches in children ranging from normal to serious causes.

Children’s headaches can be related to ailments, from allergies to ear infections to sinus problems, and most of the time they don’t indicate a dangerous illness.

But for many parents, the shadow of a terrible diagnosis lurks in the corner of the darkened room where a headachy child is lying with a cool cloth on her brow.

Sometimes, children with headaches need neuroimaging — brain CTs or MRIs. But recently several large studies have raised concerns about CT scans done on children because the radiation from these scans can increase the risk of eventually developing cancer, though that overall risk is still very small.

Doctors are being asked to follow guidelines for judicious use of these scans, but many parents remain unaware of the risks and guidelines. A study in the journal Pediatrics looked at a huge group of children who each saw a doctor at least twice with headaches but had no injury or trauma. More than 25 percent of those children got CT scans, the researchers found.

Children who brought their aching heads into emergency rooms were more likely to get scans than children visiting their regular doctors or neurology clinics.

“However, even outside the emergency room, the use of CT scans was quite high,” said Andrea DeVries, a director of research at HealthCore, a subsidiary of the insurer WellPoint, and the lead author of the study. About two-thirds of the children who received CT scans did not visit an emergency room, she noted.

Who does need neuroimaging? Doctors worry about a severe headache that gets worse, and about any abnormalities on the physical exam or changes that suggest a pathology in the brain. These changes can range from disturbances in gait or eye movements to confusion and lethargy.

Though nausea and vomiting commonly go along with migraines, vomiting can also indicate increased pressure in the brain. It can be a danger sign in a child who has recently had a concussion.

Symptoms like these quickly push a headache into the realm of a neurological emergency. Headaches that wake children from sleep or occur on just one side also may be cause for concern.

For children whose headaches don’t fit a clear migraine pattern, an eye exam is an important diagnostic step, said Dr. Andrew Lee, a neuro-ophthalmologist at the Methodist Hospital in Houston. An exam is also critical if parents have noticed any crossing of the eyes.

In serious situations, the eye exam may reveal signs of increased pressure in the brain. On a more mundane level, an exam may find that a child’s headache is caused by eye strain.

“The mother and father might not notice till reading age, third grade or fourth grade,” Lee said. Headaches that come on at that age, and are made worse by homework or reading, can be treated with glasses to correct poor vision and exercises to strengthen the eye movements.

And then there’s concussion. A 2012 study that looked at children who had head trauma found that three months after their injuries, many reported headaches. Most of the time, these children improve, but some will have headaches for months, and a very small percentage may have them for more than a year.

Heidi Blume, a pediatric neurologist at Seattle Children’s Hospital and lead author of the study, invoked a “SMART” mnemonic for helping children deal with their recurrent headaches. S is for sleep, she said, and getting enough of it. M is for not skipping meals and drinking enough to be properly hydrated. A is for physical activity, because too much or too little can lead to headaches, and R is for relaxation. T is for triggers to avoid, like cigarette smoke or particular foods.

Children can take painkillers (acetaminophen, ibuprofen and others; children should not take aspirin). Those with migraines may also benefit from preventive medicines. Counseling and biofeedback are important: Headaches can be triggered by stress, and living with chronic pain can cause depression. One goal in headache clinics is getting children back to school and helping them navigate regular activities while still avoiding their triggers.

“Many, many kids will outgrow their bad headaches,” said Dr. Daniel Bonthius, professor of pediatrics and neurology at the University of Iowa. “Exactly why they got the headaches and exactly why they go away, modern medicine doesn’t really understand.”

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Botox reduces the impact of chronic migraine

This article summarizes data supporting the use of "botox" for migraine treatment. JR

Neurology. 2011 Sep 28. [Epub ahead of print]

OnabotulinumtoxinA improves quality of life and reduces impact of chronic migraine.

Lipton RB, Varon SF, Grosberg B, McAllister PJ, Freitag F, Aurora SK, Dodick DW, Silberstein SD, Diener HC, Degryse RE, Nolan ME, Turkel CC.

Source

From the Albert Einstein College of Medicine (R.B.L., B.G.), Bronx; Montefiore Headache Center (R.B.L., B.G.), Bronx, NY; Allergan, Inc. (S.F.V., R.E.D., C.C.T.), Irvine, CA; Associated Neurologists of Southern Connecticut (P.J.M.), Fairfield, CT; Baylor University Medical Center (F.F.), Dallas, TX; Swedish Neuroscience Institute (S.K.A.), Seattle, WA; Mayo Clinic Arizona (D.W.D.), Phoenix; Thomas Jefferson University (S.D.S.), Philadelphia, PA; University of Essen (H.C.D.), Essen, Germany; and Imprint Publication Science (M.E.N.), New York, NY.

Abstract

OBJECTIVE:

To assess the effects of treatment with onabotulinumtoxinA (Botox, Allergan, Inc., Irvine, CA) on health-related quality of life (HRQoL) and headache impact in adults with chronic migraine (CM).

METHODS:

The Phase III Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical program (PREEMPT 1 and 2) included a 24-week, double-blind phase (2 12-week cycles) followed by a 32-week, open-label phase (3 cycles). Thirty-one injections of 5U each (155 U of onabotulinumtoxinA or placebo) were administered to fixed sites. An additional 40 U could be administered "following the pain." Prespecified analysis of headache impact (Headache Impact Test [HIT]-6) and HRQoL (Migraine-Specific Quality of Life Questionnaire v2.1 [MSQ]) assessments were performed. Because the studies were similar in design and did not notably differ in outcome, pooled results are presented here.

RESULTS:

A total of 1,384 subjects were included in the pooled analyses (onabotulinumtoxinA, n = 688; placebo, n = 696). Baseline mean total HIT-6 and MSQ v2.1 scores were comparable between groups; 93.1% were severely impacted based on HIT-6 scores ≥60. At 24 weeks, in comparison with placebo, onabotulinumtoxinA treatment significantly reduced HIT-6 scores and the proportion of patients with HIT-6 scores in the severe range at all timepoints including week 24 (p < 0.001). OnabotulinumtoxinA treatment significantly improved all domains of the MSQ v2.1 at 24 weeks (p < 0.001).

CONCLUSIONS:

Treatment of CM with onabotulinumtoxinA is associated with significant and clinically meaningful reductions in headache impact and improvements in HRQoL.Classification of evidence:This study provides Class 1A evidence that onabotulinumtoxinA treatment reduces headache impact and improves HRQoL.

PMID:

 

21956721

 

[PubMed - as supplied by publisher]

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