The spectrum of indomethacin-responsive headaches in children and adolescents

Author:

Myers Kenneth A123ORCID,Barmherzig Rebecca4,Raj Nichelle R4,Berrahmoune Saoussen1,Ingelmo Pablo5,Saint-Martin Christine6,Khan Afsheen Q1,Kouri Megan7,Morris Cynthia89,Hershey Andrew D10,Kacperski Joanne10,Kabbouche Marielle A10,Mohamed Nada5,Rao Rashmi R11,Lagman-Bartolome Ana Marissa12,Gelfand Amy A8,Szperka Christina L4ORCID,Orr Serena L13

Affiliation:

1. Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

2. Division of Child Neurology, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada

3. Department of Neurology and Neurosurgery, Montreal Children’s Hospital, McGill University, Montreal, Quebec, Canada

4. Department of Neurology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA

5. Department of Pediatric Anesthesiology, McGill University Health Center, Montreal, Quebec, Canada

6. Department of Radiology, McGill University Health Center, Montreal, Quebec, Canada

7. Faculty of Medicine, McGill University, Montreal, Quebec, Canada

8. Child and Adolescent Headache Program, University of California San Francisco, San Francisco, CA, USA

9. Department of Child Neurology, Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, St. Louis, MO, USA

10. Departments of Pediatrics and Neurology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA

11. Department of Neurology, Louisiana State University Health Sciences Center and Children’s Hospital New Orleans, New Orleans, LA, USA

12. Division of Neurology, Hospital for Sick Children and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada

13. Division of Neurology, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Abstract

Background Headaches with marked, specific response to indomethacin occur in children, but the phenotypic spectrum of this phenomenon has not been well-studied. Methods We reviewed pediatric patients with headache showing ≥80% improvement with indomethacin, from seven academic medical centers. Results We included 32 pediatric patients (16 females). Mean headache onset age was 10.9 y (range 2–16 y). Headache syndromes included hemicrania continua (n = 13), paroxysmal hemicrania (n = 10), primary stabbing headache (n = 2), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (n = 1), primary exercise headache (n = 1) and primary cough headache (n = 1). Adverse events were reported in 13, most commonly gastrointestinal symptoms, which often improved with co-administration of gastro-protective agents. Conclusion Indomethacin-responsive headaches occur in children and adolescents, and include headache syndromes, such as primary cough headache, previously thought to present only in adulthood. The incidence of adverse events is high, and patients must be co-treated with a gastroprotective agent.

Funder

Research Institute of the McGill University Health Centre

Fonds de Recherche du Québec - Santé

Publisher

SAGE Publications

Subject

Neurology (clinical),General Medicine

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