Laura Papetti (Rome/ IT), Samuela Tarantino (Rome/ IT), Fabiana Ursitti (Rome/ IT), Romina Moavero (Rome/ IT), Martina Checchi Proietti (Rome/ IT), Giorgia Sforza (Rome/ IT), Gabriele Monte (Rome/ IT), Michela Ada Noris Ferilli (Rome/ IT), Martina Balestri (Rome/ IT), Massimiliano Valeriani (Rome/ IT)
Abstract text (incl. figure legends and references)
Questions. What have we learned in the management of pediatric migraine over the past 5 years?
Methods. We interviewed the heads of the Italian pediatric headache centers and reviewed literature data from the last 5 years.
Results. Diagnostic Criteria. The ICHD-3 still does not have a section dedicated to childhood migraine and continue to have limits when applied to developmental age. One of the most discussed points of the ICHD-3 is having again brought the minimum duration of the migraine attack to 2 hours and no longer to 1 hour as in the previous version.
Therapy. Preliminary results showed that the use of CGRP monoclonal appears to benefit adolescents with chronic refractory headaches. Pending monoclonal antibodies, pediatric migraine prophylaxis is still based on the use of traditional drugs and non-pharmacological therapies of which we have few controlled data. In 2017 the results of CHAMP trial were published.This study showed that there were not differences in reducing frequency of attacks in the amitriptyline, topiramate, and placebo groups. The study had limitations such as the long follow-up period, the behavioural interventions and the exclusion of severe migraines and younger children. Then it did not consider an untreated group to separate a real placebo effect from a placebo response.
The Covid 19 pandemic. The rest from school and reduction of stress during the lockdown of march 2020 led to a significant improvement in the headache trend also in chronic and drug resistant children. These results suggested that the management of emotional and psychological factors is mandatory for the management of headache in children and adolescents.
Conclusions. Few steps forward have been made for the management of pediatric headache in terms of facilitating the diagnostic process and drug treatment. The era of the Covid 19 pandemic showed us how much t management of anxiety, stress and depression are fundamental to reach the goal of a migraine control in children.