Unsatisfactory Response to Acute Medications Does Not Affect the Medication Overuse Headache Development in Pediatric Chronic Migraine

Abstract

Abstract Background: Chronic migraine (CM) affects 2 to 4% of paediatric patients and has a significant impact on their quality of life. While in adults CM is very often associated to medication overuse headache (MOH), in children MOH prevalence is far lower. Suboptimal response to attack therapies may lead to their reduced assumption, thus preventing MOH development in children and adolescents. The main aim of our study was to verify whether among CM patients those with a poor response to the attack therapy showed a lower frequency of MOH, compared to those responding to the analgesic drugs. We also checked whether patients receiving prophylactic therapy had a better response to rescue drugs. Lastly, we investigated the frequency of psychiatric comorbidities between responders and non-responders. Methods: We retrospectively analysed clinical data of all chronic paediatric migraineurs under the age of 18 referred to the Headache Centre at Bambino Gesù Children Hospital June 2021 and February 2023. As primary endpoints, we evaluated: 1) unresponsiveness to acute medication in the whole population, and 2) the frequency of MOH in patients responder and non-responder to abortive drugs. As secondary endpoints, we evaluated the impact of preventive treatment and psychiatric comorbidities on the responsiveness to acute medication. Results: Seventy patients with CM were assessed during the chosen period. Paracetamol was tried by 41 patients (58.5%), NSAIDs by 56 patients (80.0%), and triptans by 1 patient (1.4%). Fifty-one participants (73%) were resistant to the abortive treatment. The presence of MOH was detected in 27.1% of the whole populations. Regarding our primary aim, MOH was diagnosed in 29% of resistant patients and 22% of responders (p >0.05). Preventative treatment was prescribed to all patients. After 3 months of preventive pharmacological therapy, 65.4% of patients who did not respond to acute medications achieved a response, while 34.6% of patients who were resistant kept not responding (p < 0.05). Among the patients who responded to acute medication, 69% also responded to prophylactic therapy (p < 0.05). Psychiatric comorbidities were detected in 68.6% of patients, with no difference between responders and non-responders (72.2% vs. 67.3%; p=0.05). Conclusions: Although in pediatric CM unresponsiveness to abortive drugs is highly prevalent, it does not represent a protective factor for MOH. Moreover, responsiveness to abortive drugs is improved by pharmacological preventative treatment and it is not affected by concomitant psychiatric comorbidities.