Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers: The first multicenter Italian study

Aim:The purpose of this retrospective multicenter study was to evaluate the use and theself-perceived efficacy and tolerability of pharmacological and non-pharmacologicaltreatments 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. Anad hocquestionnaire wasused for clinical data collection.Results:Among 706 patients with primary headaches included in the study, 637 cases witha single type of headache (migraine 76%ewith and without aura in 10% and 67%respectively; tension-type headache 24%) were selected (mean age at clinical interview: 12years). Acetaminophen and non-steroidal anti-inflammatory drugs (in particularibuprofen) 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%), fol-lowed by antiepileptic drugs (7%) and pizotifen (6%), while cyproheptadine, propanolol andamitriptyline were rarely used. Pizotifen showed the best perceived efficacy and tolera-bility. 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 ef-ficacy 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%).Discussion:Non-steroidal anti-inflammatory drugs, especially ibuprofen, should bepreferred 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 treatingmigraine attack in adolescents.Non-pharmacological preventive treatments are recommended by some pediatricguidelines as first-line interventions for primary headaches and their use should beimplemented in clinical practice.Prospective multicenter studies based on larger series are warranted to better under-stand the best treatment strategies for young people with primary headaches.