Review of pediatric migraine headaches refractory to medical management.
OBJECTIVE
The surgical treatment of migraine headache is a recent innovation that has broadened the potential patient population who may benefit from craniofacial surgical techniques to millions of affected adults. However, the population at risk in the pediatric age group has not been clearly established. The present retrospective review was performed to provide demographic information of the adolescent migraine in a major children's hospital. This information is essential before considering surgical treatment of migraine in this age group.


METHODS
Five hundred eighty-eight charts of patients aged 12 to 18 years who presented to the pediatric neurology clinic with headache in 2006 were retrospectively reviewed to evaluate for the diagnosis of migraine. Data collected included headache location, frequency, duration, intensity, associated migraine symptoms, and headache precipitants, as well as the response to medical treatment.


RESULTS
Two hundred ten (36%) of 588 patients had the diagnosis of migraine headache, and 51 patients (24%) were considered refractory to the medical treatment offered. In 101 of the 210 migraine patients, anatomic location of the headaches could be identified. Thirty-nine children (19%) with refractory migraines (mean age, 14.7 years [SD, 0.3 years]) reported definitive migraine triggers.


CONCLUSIONS
A significant percentage of pediatric patients with migraine headache remain refractory to medical treatment. At present, there is no good treatment regimen for migraine headaches in the pediatric population. We believe that surgical treatment of migraine headaches may be a realistic option for these patients.
Kung
Theodore A
TA
Department of Plastic Surgery and daggerDivision of Pediatric Neurology, Rainbow Babies and Children's Hospital of the Case School of Medicine, Cleveland, Ohio, USA.
Totonchi
Ali
A
Eshraghi
Yashar
Y
Scher
Mark S
MS
Gosain
Arun K
AK
D000293:Adolescent; D000639:Amitriptyline / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000145:classification / Q000188:drug therapy / Q000601:surgery*; D018696:Neuroprotective Agents / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D018781:Tension-Type Headache / Q000150:complications; D013997:Time Factors; D000077236:Topiramate; D014665:Vasodilator Agents / Q000627:therapeutic use; D014700:Verapamil / Q000627:therapeutic use
D018712:Analgesics, Non-Narcotic; D018696:Neuroprotective Agents; D014665:Vasodilator Agents; D000077236:Topiramate; D000639:Amitriptyline; D005632:Fructose; D014700:Verapamil