ÇOCUKLUK ÇAĞI MİGRENİNDE PROFİLAKTİK TEDAVİNİN DEĞERLENDİRİLMESİ

Arzu Yılmaz; Ömer Bektaş; Serap Teber; Gülhis Deda

EVALUATION OF PROPHYLAXIS IN PEDIATRIC MIGRAINE

Year 2016, Volume: 49 Issue: 2, 107 - 113, 01.08.2016

Arzu Yılmaz Ömer Bektaş Serap Teber Gülhis Deda

Abstract

OBJECTIVE: This study is designed in order to evalute the prophylaxis in pediatric migrane. The study involved 59 migraine patients diagnosed according to the International Headache Society criterias, in our pediatric neurology outpatient clinic between January 2000-April 2011.MATERIAL AND METHODS: The patients files considered retrospectivly. We performed kranial MRI, EEG and definition of headache, frequency, duration to make a definitive diagnose. The duration and frequency of the migrane attack compared before and after the prophylaxis; evalute the prophylaxis in pediatric migrane RESULTS: The evaluation of results among the four drug comparions for duration, and visuel analog skor was significantly distinctive for valproat. Headache frequency for sertralin propranolol comparision and valproat propranolol comparision was significantly distinctive but compararision between valproat flunerazin was not distinctive. But headache duration valproat was more successful than the other therapies.CONCLUSION: Once headache is adequately evaluated and the proper diagnosis established, individual treatment needs to be developed. The limited proven efficacious medications need to be expanded and long-term outcomes measured. The mechanism of action of valproate in migraine prophylaxis may be related to facilitation of GABAergic neurotransmission. Valproate also attenuates plasma extravasation and neurogenic inflammation by interacting with the GABAA receptor. After evaluation of treatment results would we re hypothesis

Keywords

Children, Headache, Migraine, Prophylaxis

References

)L. Prensky H, ” in Principles and Practice of Pediatrics, A. Oski, Ed., pp. 2135–2136, J. B. Lippincott, Philadelphia, Pa, USA, 2nd edition, 1994.
)Tfelt-Hansen PC, Koehler PJ. History of the use of ergo- tamine and dihydroergotamine in migraine from 1906 and onward. Cephalalgia. 2008; 28: 877-86.
)Evers S, Marziniak M, Frese A, Gralow I. Placebo efficacy in childhood and adolescence migraine: an analysis of doub- le-blind and placebo-controlled studies. Cephalalgia. 2009; : 436-44.
)Wasiewski WW. Preventive therapy in pediatric migraine. J Child Neurol. 2001; 16: 71-8.
)The International Classification of Headache Disorders: nd edition. Cephalalgia. 2004; 24: 9-160.
)Johnson A, Bickel J, Lebel A. Pediatric Migraine Prescrip- tion Patterns at a Large Academic Hospital. Pediatr Neurol. ; doi: 10.1016/j.pediatrneuro
)Borge AI, Nordhagen R, Moe B, Botten G, Bakketeig LS. Prevalence and persistence of stomach ache and headache among children. Follow-up of a cohort of Norwegian child- ren from 4 to 10 years of age. Acta Paediatr. 1994; 83: 433-7.
)Bessisso MS, Bener A, Elsaid MF, Al-Khalaf FA, Huzaima KA. Pattern of headache in school children in the State of Qatar. Saudi Med J. 2005; 26: 566-70.
)Caruso JM, Brown WD, Exil G, Gascon GG. The efficacy of divalproex sodium in the prophylactic treatment of children with migraine. Headache. 2000; 40: 672-6.
)Hering R, Kuritzky A. Sodium valproate in the prophyla- ctic treatment of migraine: a double-blind study versus pla- cebo. Cephalalgia. 1992; 12: 81–4.
)Sorge F, De Simone R, Marano E, Nolano M, Orefice G, Carrieri P. Flunarizine in prophylaxis of childhood migraine. A double-blind, placebo-controlled, crossover study. Cepha- lalgia. 1988; 8: 1-6.
)Adly C, Straumanis J, Chesson A. Fluoxetine prophylaxis of migraine. Headache. 1992; 32: 101-4.
)Silberstein SD, Goadsby PJ. Migraine: preventive treat- ment. Cephalalgia. 2002; 22: 491-512.
)Shaygannejad V, Janghorbani M, Ghorbani A, Ashtary F, Zakizade N, Nasr V. Comparison of the effect of topiramate and sodium valporate in migraine prevention: a randomized blinded crossover study. Headache. 2006; 46: 642-8.
)Ludvigsson j:Propranolol used in prophylaxis of migraine in chıldren. Acta Neurol Scand. 1974; 50: 109-115.
)Gawel MJ, Kreeft J, Nelson RF, Simard D, Arnott WS. Comparison of the efficacy and safety of flunarizine to prop- ranolol in the prophylaxis of migraine. Can J Neurol Sci. ; 19: 340-5. )Lucking CH, Oestreich W, Schmidt R, Soyka D. Fluna- rizine vs. propranolol in the prophylaxis of migraine: two double-blind comparative studies in more than 400 patients. CephalalgiA. 1988; 8: 21-6.
)Grotemeyer KH, Schlake HP, Husstedt IW. [Prevention of migraine with metoprolol and flunarizine. A double-blind crossover study]. Nervenarzt. 1988; 59: 549-52.
)Kaniecki RG. A comparison of divalproex with proprano- lol and placebo for the prophylaxis of migraine without aura. Arch Neurol. 1997; 54: 1141-5.
)Klapper JA. Toward a standard drug formulary for the tre- atment of headache. Headache. 1995; 35: 225-7.
)Rimmer EM, Richens A. An update on sodium valproate. Pharmacotherapy. 1985; 5: 171-84.
)de Tommaso M, Marinazzo D, Nitti L, Pellicoro M, Guido M, Serpino C, et al. Effects of levetiracetam vs topiramate and pla- cebo on visually evoked phase synchronization changes of alpha rhythm in migraine. Clin Neurophysiol. 2007; 118: 2297-304.
)de Tommaso M, Marinazzo D, Guido M, Libro G, Stra- maglia S, Nitti L, et al. Visually evoked phase synchronization changes of alpha rhythm in migraine: correlations with clini- cal features. Int J Psychophysiol. 2005; 57: 203-10.
)Chronicle EP, Pearson AJ, Mulleners WM. Objective as- sessment of cortical excitability in migraine with and without aura. Cephalalgia. 2006; 26: 801-8.
)Piccinelli P, Borgatti R, Nicoli F, Calcagno P, Bassi MT, Quadrelli M, et al. Relationship between migraine and epi- lepsy in pediatric age. Headache. 2006; 46: 413-21.
)Calabresi P, Galletti F, Rossi C, Sarchielli P, Cupini LM. Antiepileptic drugs in migraine: from clinical aspects to cel- lular mechanisms. Trends Pharmacol Sci. 2007; 28: 188-95.
)Artemenko AR, Kurenkov AL, Filatova EG, Nikitin SS, Kaube H, Katsarava Z. Effects of topiramate on migraine frequency and cortical excitability in patients with frequent migraine. Cephalalgia. 2008; 28: 203-8.
)Brandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, et al. Topiramate for migraine prevention: a rando- mized controlled trial. JAMA. 2004; 291: 965-73.
)Holroyd KA, Penzien DB, Cordingley GE. Propranolol in the management of recurrent migraine: a meta-analytic re- view. Headache. 1991; 31: 333-40.

ÇOCUKLUK ÇAĞI MİGRENİNDE PROFİLAKTİK TEDAVİNİN DEĞERLENDİRİLMESİ

Year 2016, Volume: 49 Issue: 2, 107 - 113, 01.08.2016

Arzu Yılmaz Ömer Bektaş Serap Teber Gülhis Deda

Abstract

AMAÇ:Kiniğimize Ocak 2000 ve Nisan 2011 tarihleri arasında başvuran, Uluslararası Başağrısı Topluluğunun "Başağrısı Bozukluklarının Uluslar Arası Sınıflandırması" ICHD-IIR1 ’nın kriterlerine göre migren tanısı konulan ve profilaksi alan 59 çocukluk çağı migren hastasının, tedavi sonuçlarını değerlendirmektir.GEREÇ VE YÖNTEMLER: Migren tanısı alan hastaların dosyaları geriye dönük olarak taranmıştır. Her bir hastanın demografik bilgileri, tanı anındaki belirti ve bulguları, ağrı sıklığı, süresi, şiddeti fizik inceleme bulguları, kranial MRI ve EEG bulguları, profilakside kullanılan ilaç, profilaksi süresi, profilaksi sonrası migren atak sıklığı ve süreleri kaydedilmiştir.BULGULAR: Migren profilaksisinde kullanılan ilaçların atak sıklığı, süresini ve visüel analog skor değerlerini azaltmada birbirleri ile karşılaştırılması yapıldığında; valproatın hem visüel analog skor, hem ağrı süresi açısından istatistiksel açıdan anlamlı olacak şekilde daha üstün olduğu tespit edilmiştir. Ağrı sıklığına ilaçların etkisi karşılaştırıldığında, valproatın, propranolole göre ve sertralinin de propranolole göre ağrı sıklığını istatistiksel olarak anlamlı olacak şekilde azalttığı tespit edilmiştir. Sıklık açısından valproatın, flunerazine oranla atak sıklığını daha iyi azalttığı görülmüş, ancak istatistiksel olarak anlamlı bulunmamıştır.SONUÇ: Migren patogenezi tam aydınlatılamamıştır ve çeşitli teoriler öne sürülmektedir. Dolayısıyla migren için en iyi profilaktik ilacın hangisi olduğu net bilinmemekte, yapılan ilaç çalışmalarının sonuçları ile değerlendirmeler yapılmaktadır. Valproatın migren profilaksisinde etkisi GABAerjik nörotransmisyonu arttırması, nörojenik inflamasyonu GABA A reseptörleri aracılığıyla azaltmasıdır. Acaba migren patofizyolojisi ile ilgili hipotezler tedavi cevapları değerlendirilerek tekrar kurulabilir mi?

Keywords

Çocukluk çağı migreni, Profilaksi, Başağrısı

References

)L. Prensky H, ” in Principles and Practice of Pediatrics, A. Oski, Ed., pp. 2135–2136, J. B. Lippincott, Philadelphia, Pa, USA, 2nd edition, 1994.
)Tfelt-Hansen PC, Koehler PJ. History of the use of ergo- tamine and dihydroergotamine in migraine from 1906 and onward. Cephalalgia. 2008; 28: 877-86.
)Evers S, Marziniak M, Frese A, Gralow I. Placebo efficacy in childhood and adolescence migraine: an analysis of doub- le-blind and placebo-controlled studies. Cephalalgia. 2009; : 436-44.
)Wasiewski WW. Preventive therapy in pediatric migraine. J Child Neurol. 2001; 16: 71-8.
)The International Classification of Headache Disorders: nd edition. Cephalalgia. 2004; 24: 9-160.
)Johnson A, Bickel J, Lebel A. Pediatric Migraine Prescrip- tion Patterns at a Large Academic Hospital. Pediatr Neurol. ; doi: 10.1016/j.pediatrneuro
)Borge AI, Nordhagen R, Moe B, Botten G, Bakketeig LS. Prevalence and persistence of stomach ache and headache among children. Follow-up of a cohort of Norwegian child- ren from 4 to 10 years of age. Acta Paediatr. 1994; 83: 433-7.
)Bessisso MS, Bener A, Elsaid MF, Al-Khalaf FA, Huzaima KA. Pattern of headache in school children in the State of Qatar. Saudi Med J. 2005; 26: 566-70.
)Caruso JM, Brown WD, Exil G, Gascon GG. The efficacy of divalproex sodium in the prophylactic treatment of children with migraine. Headache. 2000; 40: 672-6.
)Hering R, Kuritzky A. Sodium valproate in the prophyla- ctic treatment of migraine: a double-blind study versus pla- cebo. Cephalalgia. 1992; 12: 81–4.
)Sorge F, De Simone R, Marano E, Nolano M, Orefice G, Carrieri P. Flunarizine in prophylaxis of childhood migraine. A double-blind, placebo-controlled, crossover study. Cepha- lalgia. 1988; 8: 1-6.
)Adly C, Straumanis J, Chesson A. Fluoxetine prophylaxis of migraine. Headache. 1992; 32: 101-4.
)Silberstein SD, Goadsby PJ. Migraine: preventive treat- ment. Cephalalgia. 2002; 22: 491-512.
)Shaygannejad V, Janghorbani M, Ghorbani A, Ashtary F, Zakizade N, Nasr V. Comparison of the effect of topiramate and sodium valporate in migraine prevention: a randomized blinded crossover study. Headache. 2006; 46: 642-8.
)Ludvigsson j:Propranolol used in prophylaxis of migraine in chıldren. Acta Neurol Scand. 1974; 50: 109-115.
)Gawel MJ, Kreeft J, Nelson RF, Simard D, Arnott WS. Comparison of the efficacy and safety of flunarizine to prop- ranolol in the prophylaxis of migraine. Can J Neurol Sci. ; 19: 340-5. )Lucking CH, Oestreich W, Schmidt R, Soyka D. Fluna- rizine vs. propranolol in the prophylaxis of migraine: two double-blind comparative studies in more than 400 patients. CephalalgiA. 1988; 8: 21-6.
)Grotemeyer KH, Schlake HP, Husstedt IW. [Prevention of migraine with metoprolol and flunarizine. A double-blind crossover study]. Nervenarzt. 1988; 59: 549-52.
)Kaniecki RG. A comparison of divalproex with proprano- lol and placebo for the prophylaxis of migraine without aura. Arch Neurol. 1997; 54: 1141-5.
)Klapper JA. Toward a standard drug formulary for the tre- atment of headache. Headache. 1995; 35: 225-7.
)Rimmer EM, Richens A. An update on sodium valproate. Pharmacotherapy. 1985; 5: 171-84.
)de Tommaso M, Marinazzo D, Nitti L, Pellicoro M, Guido M, Serpino C, et al. Effects of levetiracetam vs topiramate and pla- cebo on visually evoked phase synchronization changes of alpha rhythm in migraine. Clin Neurophysiol. 2007; 118: 2297-304.
)de Tommaso M, Marinazzo D, Guido M, Libro G, Stra- maglia S, Nitti L, et al. Visually evoked phase synchronization changes of alpha rhythm in migraine: correlations with clini- cal features. Int J Psychophysiol. 2005; 57: 203-10.
)Chronicle EP, Pearson AJ, Mulleners WM. Objective as- sessment of cortical excitability in migraine with and without aura. Cephalalgia. 2006; 26: 801-8.
)Piccinelli P, Borgatti R, Nicoli F, Calcagno P, Bassi MT, Quadrelli M, et al. Relationship between migraine and epi- lepsy in pediatric age. Headache. 2006; 46: 413-21.
)Calabresi P, Galletti F, Rossi C, Sarchielli P, Cupini LM. Antiepileptic drugs in migraine: from clinical aspects to cel- lular mechanisms. Trends Pharmacol Sci. 2007; 28: 188-95.
)Artemenko AR, Kurenkov AL, Filatova EG, Nikitin SS, Kaube H, Katsarava Z. Effects of topiramate on migraine frequency and cortical excitability in patients with frequent migraine. Cephalalgia. 2008; 28: 203-8.
)Brandes JL, Saper JR, Diamond M, Couch JR, Lewis DW, Schmitt J, et al. Topiramate for migraine prevention: a rando- mized controlled trial. JAMA. 2004; 291: 965-73.
)Holroyd KA, Penzien DB, Cordingley GE. Propranolol in the management of recurrent migraine: a meta-analytic re- view. Headache. 1991; 31: 333-40.

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Details

Primary Language	Turkish
Journal Section	Original Research Article
Authors	Arzu Yılmaz This is me Ömer Bektaş This is me Serap Teber This is me Gülhis Deda This is me
Publication Date	August 1, 2016
Published in Issue	Year 2016 Volume: 49 Issue: 2

Cite

AMA	Yılmaz A, Bektaş Ö, Teber S, Deda G. ÇOCUKLUK ÇAĞI MİGRENİNDE PROFİLAKTİK TEDAVİNİN DEĞERLENDİRİLMESİ. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. August 2016;49(2):107-113.

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