and Acute Treatment in Pediatric Migraine小儿偏头痛的诊断和治疗急性课件.pptVIP

CCHMC Headache Center currently has a multi site (~30 sites) double placebo controlled trial to study best preventative headache medication (TPM vs AMI) in ages 8-17 years Cyproheptadine: More effective in younger children. Comes in tablet and syrup formulation for kids who aren’t pill swallowers. Well tolerated. Most common side effect is weight gain. Sedation possible but less likely if slowly titrated. Target dose: 0.25-0.5 mg/kg divided over 2 doses. Beta Blockers: Initial study showed effectiveness, but results have not been replicated. Target Dose: 40 mg BID. Avoid use in kids with Asthma and Depression. Calcium Channel Blockers: Lack of data in pediatric literature. Flunarizine available in Europe- study showed effectiveness but results can’t be generalized to other CCB’s. Need baseline ECG and recheck when on med. Rarely used in HA Center. Botox: Used in patients who have failed multiple preventative medications. Not always an easy sell to kids! Used in conjunction with other meds, not as sole agent. Injections given to forehead, temple, neck and shoulder area. Expecting FDA approval for chronic migraine in adults-may lead to pediatric trials. Very expensive and difficult to get insurance coverage at this time. * First approved 21 years ago by the FDA for 2 eye muscle disorders - strabismus and blepharospasms. Botox is a bacteria that comes from the soil Prempt study helped to gain FDA approval for botox (October 2012) in pts 18. Currently Botox is now approved for chronic migraine in adults, strabismus, hyperhydrosis of axilla, upper limb spasticity, cervial dystonia and blepharospasms A series of injections for Botox are usually about 31-38 injections across the forehead, in the back of the head, along the side of the neck and in the shoulders. The areas of the injections are usually the nerve areas in the tissue area that contain the nerves that come from the brain. * * * Overall this slide shows that a migraneur has a sensitive brain