Accepted Article
Received Date : 09-Jan-2014 Revision Date : 20-Mar-2013 Accepted Date : 15-Jul-2014 Article type
: Regular Article
The Paediatric Migraine Disability Assessment Score is a useful tool for evaluating prophylactic migraine treatment
Yasemin Topcu, MD (Dokuz Eylul University Hospital, Division of Pediatric Neurology, Izmir, TURKEY) ([email protected]) Tel:+90 5054934070
Semra Hiz Kurul, Prof. Dr. (Dokuz Eylul University Hospital, Division of Pediatric Neurology, Izmir, TURKEY) ([email protected])
Erhan Bayram, MD (Dokuz Eylul University Hospital, Division of Pediatric Neurology, Izmir, TURKEY) ([email protected])
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/apa.12752 This article is protected by copyright. All rights reserved.
Accepted Article
Kaan Sozmen, MD, MSc (Katip Celebi University, Department of Public Health, Izmir)
Uluc Yis, Assoc. Prof. Dr. (Dokuz Eylul University Hospital, Division of Pediatric Neurology, Izmir, TURKEY) ([email protected])
Conflict of interest: None of the authors have any conflict of interest. Running title: Evaluating migraine prophylaxis
Corresponding Author Yasemin Topçu Dokuz Eylul University Hospital, Department of Pediatrics, Division of Paediatric Neurology, Narlidere, 35340, Izmir,Turkey Phone: 90 505 493 40 70 Fax: 90 232 412 36 49 e-mail: [email protected]
ABSTRACT Aim: There is a need for an objective assessment scoring system to evaluate the effectiveness of prophylactic drugs in paediatric migraine and the aim of this study was to evaluate the Paediatric Migraine Disability Assessment score (PedMIDAS).
This article is protected by copyright. All rights reserved.
Accepted Article
Methods: We recruited 88 children aged between six and 17-years-of-age with migraine. The 53 children in the treatment group were divided into three groups according to the prophylactic drug they received topiramate, flunarizine and propranolol and assessed using PedMIDAS before the start of treatment and three and six months after treatment. The 35 patients in the control group did not receive prophylactic treatment and were assessed with PedMIDAS on three occasions, three months apart. Results: Topiramate, propranolol and flunarizine treatments significantly decreased PedMIDAS scores and were shown to be effective in improving the patients’ quality of life. Topiramate and propranolol were more effective than flunarizine. The number of days on analgesic treatment significantly decreased in the patients who had received topiramate and propranolol treatments (p0.05). Conclusions: The PedMIDAS scoring system is useful in evaluating the efficacy of prophylactic therapy in paediatric migraine. Topiramate and propronalol lowered the PedMIDAS scores better than flurinazine.
Key words: child, migraine, PedMIDAS, topiramate, flunirazine, propranolol
Key Notes •
There is a need for an objective assessment scoring system to evaluate the effectiveness of prophylactic drugs in paediatric migraine and this study evaluated the Paediatric Migraine Disability Assessment score (PedMIDAS).
•
We recruited 88 children aged between six and 17-years-of-age with migraine and compared the 53 treated with one of three prophylactic drugs with 35 controls.
This article is protected by copyright. All rights reserved.
Accepted Article
•
Our findings showed that topiramate and propronalol lowered the PedMIDAS scores better than flurinazine.
INTRODUCTION The Paediatric Migraine Disability Assessment score (PedMIDAS) is an important tool that monitors treatment responses and can be easily used in paediatric neurology clinics (1). Although many studies have suggested its use, PedMIDAS has not been widely used in routine clinical evaluations and treatment modalities in Turkey. Pakalnis et al used PedMIDAS to assess migraine patients who were given levetiracetam prophylaxis, reporting that the pre-treatment mean PedMIDAS score of 45.6 decreased to 12.1 with treatment, which was considered highly significant (2). Hirfanoğlu et al also reported a significant decrease in the PedMIDAS scores of patients having migraine after prophylactic treatment (3). Lewis et al used PedMIDAS to evaluate the disability and quality of life of children with basilar-type migraine who received topiramate prophylaxis and observed significant improvements after treatment (4). The PedMIDAS scores of adolescents and children who had coenzyme Q deficiency and migraine were reported to decrease from 47.4 ± 50.6 to 22.8 ± 30.6 after treatment (5). These studies suggest that PedMIDAS scoring provides an important tool in monitoring responses to treatment. It can easily be applied to patients during outpatient follow-up appointments and the patients' quality of life can be improved through timely and effective treatment modifications.
MATERIAL AND METHODS This study was carried out between September 2010 and March 2012 at the Pediatric Neurology Department of the Medical Faculty of Dokuz Eylul University, Turkey. We completed a headache questionnaire for patients who were admitted with recurrent headache and then divided them into subgroups, according to the International Headache Society 2004 criteria. Patients who were diagnosed with migraine were monitored for at least six months. The study was approved by the local ethics board (study protocol number: 42-GOA).
This article is protected by copyright. All rights reserved.
Accepted Article
The study included patients with migraine, who were aged between six and 17 years and had normal physical and neurological examinations, no history of a serious chronic disease and were not taking any prescribed medication for the condition. Patients with an organic aetiology and severe psychiatric comorbidity were excluded. We used six questions from the PedMIDAS questionnaire to ask patients about their headache problems during the past three months and this provided us with scores for the total number of days when their migraine stopped them from attending school or taking part in daily and social activities. Analgesic drugs taken for headaches, average number of days with migraine and number of days when medication was taken were all recorded. All patients were given a separate headache pain diary and asked to register all the relevant information in it. We explained how to use the diary and stressed the importance of using it. Indications for prophylactic treatment were: poor daily life activities due to migraine, three to four migraine attacks a month, history of analgesic overuse and a contraindication to acute treatment. Treatment choices were made between commercialised drugs with proven therapeutic efficiency that were available in our country. The side-effect profiles of the drugs were also taken into consideration, as well as the patients’ individual differences, such as age, weight for height, personal history, and school success (6, 7). Prophylactic treatment was used in accordance with the literature. The following doses were used: propranolol 20-40 mg/day, flunarizine 5-10 mg/day, topiramate 1-2mg/kg/day, sodium valproate 10-20 mg/kg/day and cyproheptadine 0.2 mg/kg /day (6, 7).
Follow-Up Assessment Data All patients with a diagnosis of migraine were physically examined at admission, and at one, three and six months, and asked about the frequency, duration and intensity of their migraines, together with any accompanying symptoms. The PedMIDAS survey was applied a total of three times, at admission and at the third and sixth months. According to the PedMIDAS grading scale, patients with
This article is protected by copyright. All rights reserved.
Accepted Article
a PedMIDAS score of zero to 10 were considered to be Grade I, 10-30 were Grade II, 31-50 were Grade III, and more than 50 were grade IV. To evaluate the patients’ response to treatment, the mean number of days with headache per month, and the number of days when they used analgesic drugs, were also recorded.
Statistical Analysis Statistical analysis of the data was performed with the Statistical Package for Social Sciences (SPSS) Software for Windows, version 15.0 programme and the results were expressed as mean ± standard deviation (SD). Pearson's chi-square test or Fisher's exact test were used to compare categorical variables. For more than two groups with normal distribution, one-way analysis of variance (ANOVA) was used to compare continuous variables and the Student's t-test was used for paired comparisons. For more than two groups with abnormal distribution, or with a limited number of subjects, the Kruskal-Wallis test was used to compare group medians, while the Mann-Whitney U test was used to compare the two groups. Before and after treatment, the Wilcoxon test was used to compare mean values in the groups. We accepted p 50)
This article is protected by copyright. All rights reserved.
Accepted Article This article is protected by copyright. All rights reserved.
Received Date : 09-Jan-2014 Revision Date : 20-Mar-2013 Accepted Date : 15-Jul-2014 Article type
: Regular Article
The Paediatric Migraine Disability Assessment Score is a useful tool for evaluating prophylactic migraine treatment
Yasemin Topcu, MD (Dokuz Eylul University Hospital, Division of Pediatric Neurology, Izmir, TURKEY) ([email protected]) Tel:+90 5054934070
Semra Hiz Kurul, Prof. Dr. (Dokuz Eylul University Hospital, Division of Pediatric Neurology, Izmir, TURKEY) ([email protected])
Erhan Bayram, MD (Dokuz Eylul University Hospital, Division of Pediatric Neurology, Izmir, TURKEY) ([email protected])
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/apa.12752 This article is protected by copyright. All rights reserved.
Accepted Article
Kaan Sozmen, MD, MSc (Katip Celebi University, Department of Public Health, Izmir)
Uluc Yis, Assoc. Prof. Dr. (Dokuz Eylul University Hospital, Division of Pediatric Neurology, Izmir, TURKEY) ([email protected])
Conflict of interest: None of the authors have any conflict of interest. Running title: Evaluating migraine prophylaxis
Corresponding Author Yasemin Topçu Dokuz Eylul University Hospital, Department of Pediatrics, Division of Paediatric Neurology, Narlidere, 35340, Izmir,Turkey Phone: 90 505 493 40 70 Fax: 90 232 412 36 49 e-mail: [email protected]
ABSTRACT Aim: There is a need for an objective assessment scoring system to evaluate the effectiveness of prophylactic drugs in paediatric migraine and the aim of this study was to evaluate the Paediatric Migraine Disability Assessment score (PedMIDAS).
This article is protected by copyright. All rights reserved.
Accepted Article
Methods: We recruited 88 children aged between six and 17-years-of-age with migraine. The 53 children in the treatment group were divided into three groups according to the prophylactic drug they received topiramate, flunarizine and propranolol and assessed using PedMIDAS before the start of treatment and three and six months after treatment. The 35 patients in the control group did not receive prophylactic treatment and were assessed with PedMIDAS on three occasions, three months apart. Results: Topiramate, propranolol and flunarizine treatments significantly decreased PedMIDAS scores and were shown to be effective in improving the patients’ quality of life. Topiramate and propranolol were more effective than flunarizine. The number of days on analgesic treatment significantly decreased in the patients who had received topiramate and propranolol treatments (p0.05). Conclusions: The PedMIDAS scoring system is useful in evaluating the efficacy of prophylactic therapy in paediatric migraine. Topiramate and propronalol lowered the PedMIDAS scores better than flurinazine.
Key words: child, migraine, PedMIDAS, topiramate, flunirazine, propranolol
Key Notes •
There is a need for an objective assessment scoring system to evaluate the effectiveness of prophylactic drugs in paediatric migraine and this study evaluated the Paediatric Migraine Disability Assessment score (PedMIDAS).
•
We recruited 88 children aged between six and 17-years-of-age with migraine and compared the 53 treated with one of three prophylactic drugs with 35 controls.
This article is protected by copyright. All rights reserved.
Accepted Article
•
Our findings showed that topiramate and propronalol lowered the PedMIDAS scores better than flurinazine.
INTRODUCTION The Paediatric Migraine Disability Assessment score (PedMIDAS) is an important tool that monitors treatment responses and can be easily used in paediatric neurology clinics (1). Although many studies have suggested its use, PedMIDAS has not been widely used in routine clinical evaluations and treatment modalities in Turkey. Pakalnis et al used PedMIDAS to assess migraine patients who were given levetiracetam prophylaxis, reporting that the pre-treatment mean PedMIDAS score of 45.6 decreased to 12.1 with treatment, which was considered highly significant (2). Hirfanoğlu et al also reported a significant decrease in the PedMIDAS scores of patients having migraine after prophylactic treatment (3). Lewis et al used PedMIDAS to evaluate the disability and quality of life of children with basilar-type migraine who received topiramate prophylaxis and observed significant improvements after treatment (4). The PedMIDAS scores of adolescents and children who had coenzyme Q deficiency and migraine were reported to decrease from 47.4 ± 50.6 to 22.8 ± 30.6 after treatment (5). These studies suggest that PedMIDAS scoring provides an important tool in monitoring responses to treatment. It can easily be applied to patients during outpatient follow-up appointments and the patients' quality of life can be improved through timely and effective treatment modifications.
MATERIAL AND METHODS This study was carried out between September 2010 and March 2012 at the Pediatric Neurology Department of the Medical Faculty of Dokuz Eylul University, Turkey. We completed a headache questionnaire for patients who were admitted with recurrent headache and then divided them into subgroups, according to the International Headache Society 2004 criteria. Patients who were diagnosed with migraine were monitored for at least six months. The study was approved by the local ethics board (study protocol number: 42-GOA).
This article is protected by copyright. All rights reserved.
Accepted Article
The study included patients with migraine, who were aged between six and 17 years and had normal physical and neurological examinations, no history of a serious chronic disease and were not taking any prescribed medication for the condition. Patients with an organic aetiology and severe psychiatric comorbidity were excluded. We used six questions from the PedMIDAS questionnaire to ask patients about their headache problems during the past three months and this provided us with scores for the total number of days when their migraine stopped them from attending school or taking part in daily and social activities. Analgesic drugs taken for headaches, average number of days with migraine and number of days when medication was taken were all recorded. All patients were given a separate headache pain diary and asked to register all the relevant information in it. We explained how to use the diary and stressed the importance of using it. Indications for prophylactic treatment were: poor daily life activities due to migraine, three to four migraine attacks a month, history of analgesic overuse and a contraindication to acute treatment. Treatment choices were made between commercialised drugs with proven therapeutic efficiency that were available in our country. The side-effect profiles of the drugs were also taken into consideration, as well as the patients’ individual differences, such as age, weight for height, personal history, and school success (6, 7). Prophylactic treatment was used in accordance with the literature. The following doses were used: propranolol 20-40 mg/day, flunarizine 5-10 mg/day, topiramate 1-2mg/kg/day, sodium valproate 10-20 mg/kg/day and cyproheptadine 0.2 mg/kg /day (6, 7).
Follow-Up Assessment Data All patients with a diagnosis of migraine were physically examined at admission, and at one, three and six months, and asked about the frequency, duration and intensity of their migraines, together with any accompanying symptoms. The PedMIDAS survey was applied a total of three times, at admission and at the third and sixth months. According to the PedMIDAS grading scale, patients with
This article is protected by copyright. All rights reserved.
Accepted Article
a PedMIDAS score of zero to 10 were considered to be Grade I, 10-30 were Grade II, 31-50 were Grade III, and more than 50 were grade IV. To evaluate the patients’ response to treatment, the mean number of days with headache per month, and the number of days when they used analgesic drugs, were also recorded.
Statistical Analysis Statistical analysis of the data was performed with the Statistical Package for Social Sciences (SPSS) Software for Windows, version 15.0 programme and the results were expressed as mean ± standard deviation (SD). Pearson's chi-square test or Fisher's exact test were used to compare categorical variables. For more than two groups with normal distribution, one-way analysis of variance (ANOVA) was used to compare continuous variables and the Student's t-test was used for paired comparisons. For more than two groups with abnormal distribution, or with a limited number of subjects, the Kruskal-Wallis test was used to compare group medians, while the Mann-Whitney U test was used to compare the two groups. Before and after treatment, the Wilcoxon test was used to compare mean values in the groups. We accepted p 50)
This article is protected by copyright. All rights reserved.
Accepted Article This article is protected by copyright. All rights reserved.
