Which of the drugs has been shown to be effective in the prophylaxis of migraine in children?

By | May 13, 2012

Which of the following medications has been shown to be effective in the prophylaxis of basilar-type migraine in children?

A. Propranolol (Inderal)

B. Topiramate (Topamax)

C. Gabapentin (Neurontin)

D. Lamotrigine (Lamictal)

E. All of the above

The answer is B. Basilar-type migraine represents up to 20% of migraine headaches in children and adolescents. This primary headache, which may be a symptom-specific type of migraine with aura, is characterized by attacks that include symptoms of dizziness, vertigo, visual disturbances, ataxia, and diplopia, followed by migraine headache. A double-blind, parallel-group, dose comparison study assessed the efficacy and safety of topiramate (Topamax) for prophylaxis of basilar-type migraine in children and adolescents. Fourteen children (4 boys, 10 girls) were randomized to treatment with either 25 mg/day or 100 mg/day of topiramate. The study found that 86% of the children and adolescents responded with a greater than 50% reduction in migraine frequency without serious adverse events. The authors concluded that preventive therapy with topiramate resulted in a reduction of the overall migraine frequency and the frequency of attacks of basilar-type migraine at both 25 mg and 100 mg doses relative to a historical baseline and prospective baseline periods. (Lewis & Paradiso, Headache 2007)

What is the most common neuropsychiatric manifestation of systemic lupus erythematosus in children?

A. Headaches

B. Seizures

C. Psychosis

D. Cognitive dysfunction

E. Chorea

The answer is A. Neuropsychiatric manifestations, which often occur early in the disease, are found in about a quarter of children and adolescents with systemic lupus erythematosus. Headaches (66%), psychosis (36%), cognitive dysfunction (27%), and cerebrovascular disease (24%) are the most common neuropsychiatric manifestations; although seizures, chorea, and peripheral nerve disease are also common. Children may have multiple neuropsychiatric manifestations of the disease simultaneously and may suffer long-term damage from these disorders. (Benseler & Silverman, Lupus 2007)

Which statement best describes headache in pregnancy and the postpartum period?

A. Headaches during pregnancy and the postpartum period are rare, afflicting less than 10% of women.

B. Headaches in pregnant or postpartum women with a past history of headaches are usually migraine headaches.

C. A secondary headache is a rare cause of a new-onset headache during pregnancy or the postpartum period.

D. Migraine headaches worsen as pregnancy progress.

E. Headaches are rare after pregnancy in the setting of hormonal changes and sleep deprivation.

The answer is B. Women of childbearing age are frequently afflicted with common primary headache disorders such as migraine and TTH. The prevalence of headaches during pregnancy or the immediate postpartum period is reported to be as high as 35%. During pregnancy and the postpartum period, women may have new-onset headaches that are generally primary. A woman’s first migraine may occur during pregnancy. However, some of these new-onset headaches may be secondary to cerebrovascular disorders or mass lesions. In a prospective evaluation of 1, 101 pregnant women with a headache history, Melhado et al. (2007) found that headaches during gestation were due to migraine in over 80% of women with a pregestational headache history. Generally, these migraine headaches improve or resolve after the end of the first trimester. However, in the rare women with a new-onset headache during pregnancy, over half had a secondary headache. Less than half of pregnant women with a new-onset headache, without any prior headache history, ended up having a primary headache disorder. Emergent neuroimaging should be obtained when appropriate, since studies reveal underlying headache pathology, both in the brain and in sinuses, in up to a quarter of pregnant women with new-onset headache. (Melhado, Maciel, & Guerreiro, Can J Neurol Sci 2007)