title: Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers: The first multicenter Italian study.
abstract: OBJECTIVE
  The purpose of this retrospective multicenter study was to evaluate the use and the self-perceived efficacy and tolerability of pharmacological and non-pharmacological treatments in children and adolescents with primary headaches.
  
  
  METHODS
  Study of a cohort of children and adolescents diagnosed with primary headache, consecutively referred to 13 juvenile Italian Headache Centers. An ad hoc questionnaire was used for clinical data collection.
  
  
  RESULTS
  Among 706 patients with primary headaches included in the study, 637 cases with a single type of headache (migraine 76% - with and without aura in 10% and 67% respectively; tension-type headache 24%) were selected (mean age at clinical interview: 12 years). Acetaminophen and non-steroidal anti-inflammatory drugs (in particular ibuprofen) were commonly used to treat attacks, by 76% and 46% of cases respectively. Triptans were used overall by 6% of migraineurs and by 13% of adolescents with migraine, with better efficacy than acetaminophen and non-steroidal anti-inflammatory drugs. Preventive drugs were used by 19% of migraineurs and by 3% of subjects with tension-type headache. In migraineurs, flunarizine was the most frequently used drug (18%), followed by antiepileptic drugs (7%) and pizotifen (6%), while cyproheptadine, propanolol and amitriptyline were rarely used. Pizotifen showed the best perceived efficacy and tolerability. Melatonin and nutraceuticals were used by 10% and 32% of subjects, respectively, both for migraine and tension-type headache, with good results in terms of perceived efficacy and tolerability. Non-pharmacological preventive treatments (i.e. relaxation techniques, biofeedback, cognitive-behavioral therapy, acupuncture) were used only by 10% of cases (migraine 9%, tension-type headache 15%).
  
  
  CONCLUSIONS
  Non-steroidal anti-inflammatory drugs, especially ibuprofen, should be preferred to acetaminophen for acute attacks of migraine or tension-type headache, because they were usually more effective and well tolerated. Triptans could be used more frequently as first or almost second choice for treating migraine attack in adolescents. Non-pharmacological preventive treatments are recommended by some pediatric guidelines as first-line interventions for primary headaches and their use should be implemented in clinical practice. Prospective multicenter studies based on larger series are warranted to better understand the best treatment strategies for young people with primary headaches.
authors.affiliation: Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: irene.toldo@unipd.it.
authors.forename: Irene
authors.initials: I
authors.lastname: Toldo
authors.affiliation: Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: martina.rattin@libero.it.
authors.forename: Martina
authors.initials: M
authors.lastname: Rattin
authors.affiliation: Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy. Electronic address: egle.perissinotto@unipd.it.
authors.forename: Egle
authors.initials: E
authors.lastname: Perissinotto
authors.affiliation: Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: debora.decarlo@hotmail.it.
authors.forename: Debora
authors.initials: D
authors.lastname: De Carlo
authors.affiliation: Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: dottbarbara@yahoo.it.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bolzonella
authors.affiliation: Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: margherita.nosadini@gmail.com.
authors.forename: Margherita
authors.initials: M
authors.lastname: Nosadini
authors.affiliation: Second Paediatric Department, University of Milan, Italy. Electronic address: livia.rossi@unimi.it.
authors.forename: Livia Nicoletta
authors.initials: LN
authors.lastname: Rossi
authors.affiliation: Child Neuropsychiatry Division, University of Palermo, Italy. Electronic address: cefalee.neuroriabilitazione@ausl6palermo.org.
authors.forename: Angelo
authors.initials: A
authors.lastname: Vecchio
authors.affiliation: Department of Neurological Sciences, University of Verona, Italy. Electronic address: alessandro.simonati@univr.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Simonati
authors.affiliation: Juvenile Headache Centre, Second University of Naples, Italy. Electronic address: marco.carotenuto@unina2.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Carotenuto
authors.affiliation: Juvenile Headache Centre, University Hospital of Florence, Italy. Electronic address: centrocefalee@meyer.it.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Scalas
authors.affiliation: Paediatric Neurology, ''Giovanni XXIII'' Hospital Policlinico of Bari, Italy. Electronic address: vsciru@tin.it.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Sciruicchio
authors.affiliation: Child Neuropsychiatry Division, "G.F. Ingrassia" Hospital, AUSL n°6, Palermo, Italy. Electronic address: vinzi.raielk@inwind.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Raieli
authors.affiliation: Child and Juvenile Neuropsychiatry Unit, ASL n°4, Terni, University of Perugia, Italy. Electronic address: giovanni.mazzotta@unipg.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mazzotta
authors.affiliation: Department of Experimental Medicine, University of L'Aquila, Italy. Electronic address: elisabetta.tozzialleva@univaq.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tozzi
authors.affiliation: Headache Centre, Division of Neurology, Children's Hospital Bambino Gesú, Rome, Italy. Electronic address: valeriani@opbg.net.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Valeriani
authors.affiliation: Child and Adolescent Neuropsychiatry, University Hospital of Cagliari, Italy. Electronic address: cianchet@unica.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cianchetti
authors.affiliation: Child Neuropsychiatry Unit, C. Mondino National Neurological Institute, Pavia, Italy. Electronic address: umberto.balottin@unipv.it.
authors.forename: Umberto
authors.initials: U
authors.lastname: Balottin
authors.affiliation: Department of Pediatrics and Child and Adolescent Neuropsychiatry, University "La Sapienza" of Rome, Italy. Electronic address: vincenzo.guidetti@uniroma1.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Guidetti
authors.affiliation: Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: stefano.sartori@unipd.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Sartori
authors.affiliation: Juvenile Headache Centre, University Hospital of Padua, Italy. Electronic address: pierantonio.battistella@unipd.it.
authors.forename: Pier Antonio
authors.initials: PA
authors.lastname: Battistella
mesh_terms: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D001521:Behavior Therapy; D002648:Child; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy / Q000628:therapy*; D010372:Pediatrics / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D018781:Tension-Type Headache / Q000188:drug therapy / Q000628:therapy*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants
keywords: Adolescents; Children; Migraine; Primary headaches; Tension-type headache; Treatment