Christina L. Szperka

Anti–N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis in Children and Adolescents

To report the clinical features of anti–N‐methyl‐D‐aspartate receptor (NMDAR) encephalitis in patients ≤ 18 years old.

Quality improvement in neurology: Child neurology quality measure set: Executive summary

Childhood neurologic disorders, as a group, include relatively common conditions such as migraine (prevalence between 3% and 10.6% in children 3–15 years of age1,2), transient tic disorders (TDs) (3%),3 and specifically Tourette syndrome (TS) (0.8%),3 and rarer disorders such as infantile spasms that may occur in only about 1,200 infants each year in the United States. These disorders account for a disproportionately higher number of emergency department visits, intensive care admissions, deaths, and higher costs when compared to other childhood illness.4 Generally, delivery of quality care should improve outcomes and result in decreased unnecessary utilization of health services.4

Patterns of Use of Peripheral Nerve Blocks and Trigger Point Injections for Pediatric Headache: Results of a Survey of the American Headache Society Pediatric and Adolescent Section

To describe current patterns of use of nerve blocks and trigger point injections for treatment of pediatric headache.

Emergency and Inpatient Treatment of Migraine: An American Headache Society Survey

Objective: To determine the medication and management preferences of headache specialists in treating migraine in the ED and during inpatient hospitalization. Background: Despite the frequency of migraine as a presenting complaint and the cost of acute treatment, there is no clear consensus on the standard of care for acute migraine management in the ED or during hospitalization. Methods: The American Headache Society (AHS) Special Interest Group for Inpatient and Emergency Care developed an online survey that was distributed to AHS members. Results: There were 106 survey respondents, 87 of whom completed all 13 questions. The most frequent choices for first-line ED migraine treatment in an otherwise healthy adult were dopamine antagonists (58.7%), non-steroidal anti-inflammatory drugs (NSAID) (49.0%), and IV hydration (48.1%). The most frequently selected second-line treatments were valproic acid, dihydroergotamine (DHE), and NSAIDs. Opioids were Original Research Article British Journal of Medicine & Medical Research, 4(20): 3800-3813, 2014 3801 chosen by 1% for first line and 4.8% for second line. No respondents selected barbiturate containing medications for either treatment. The most frequently selected medications for initial treatment during inpatient hospitalization for migraine were DHE (64.5%), dopamine antagonists (61.3), and NSAID (37.6%). The most frequent adjunctive treatments were valproic acid and corticosteroids. Vomiting, medication overuse with opioids or barbiturates, and ED recidivism were the most frequently selected indications for inpatient treatment. The majority of respondents (71%) indicated they would taper or stop opioid medication as a part of migraine treatment in patients admitted for intractable migraine who were taking opioids for an unrelated indication such as low back pain. Commonly selected ancillary services included psychology (80.6%), physical therapy (64.5%), nutrition (50.5%), and psychiatry (46.2%). The majority of respondents (79.3%) indicated that outpatient follow-up should occur within 4 weeks of discharge from the hospital. Conclusions: Headache specialists indicated neuroleptics, NSAID and migraine-specific agents should be considered before opioids or barbiturates for both adults and children with migraine. There was consensus that worsening or refractory migraine treatment should not include the escalation of chronic opioids. Opinion suggested that opioid or barbiturate overuse is more likely to warrant inpatient treatment than triptan or NSAID overuse. Multidisciplinary care and close follow-up are important components of inpatient migraine treatment.

The Changing Landscape of Pediatric Migraine Therapy: A Review

Importance Migraine is a disabling and prevalent condition that affects the pediatric and adolescent population. This review describes current acute and preventive migraine pharmacologic therapies for the pediatric and adolescent population. Observations Multiple pharmacotherapies that have been used in the treatment of acute headache and prevention in pediatric migraine are reviewed. There have been recent advances in the management of migraines among pediatric and adolescent patients, including US Food and Drug Administration approval of triptans for acute management in children as young as 6 years, and the first prospective, randomized, double-blind, placebo-controlled comparative study of preventive pharmacotherapy in pediatric migraine. A major challenge of evidence-based research in pediatric and adolescent migraine is the significant placebo effect. Conclusions and Relevance Although progress is being made in the management of migraines among pediatric and adolescent patients, there remains much work to be done.

Reasons for Manuscript Rejection After Peer Review From the Journal Headache

To identify and characterize the reasons manuscripts are rejected after peer review from the journal Headache.

Recommendations on the Use of Anti-CGRP Monoclonal Antibodies in Children and Adolescents: Headache

Migraine is common in children and adolescents and can have long-term consequences on educational performance, self-esteem, and cognitive well-being1,2. However, effective, well-tolerated, evidence-based therapies for migraine prevention in children and adolescents remain limited3. In adults, monoclonal antibodies (mAbs) to calcitonin gene-related peptide (CGRP), or its receptor, have been shown to be efficacious for migraine prevention 4–11, and in episodic cluster headache 12. Although CGRP is expressed in multiple body systems13, trials to date have demonstrated minimal adverse events. The most commonly seen adverse events in adult trials included: injection site reactions, upper respiratory symptoms and constipation. These treatments avoid the need for daily pill taking, and thus may improve adherence, which is known to be low with oral migraine preventives14. Pediatric and adolescent migraine prevention trials will follow; however, outcome data from these will likely not be available for several years. In the interim, the decision regarding whether to treat pediatric patients with anti-CGRP mAbs will require providers to balance the potential for unknown risks against the potential benefits of the therapy. To bridge the gap until empiric data become available, this manuscript, written by members of the Pediatric & Adolescent Headache special interest group of the American Headache Society, is meant to serve as expert opinion, i.e. class IV evidence, on the use of these antibodies in children and adolescents. This topic was discussed at the Pediatric & Adolescent Headache special interest group (SIG) meeting at the 2018 Annual Scientific Meeting of the American Headache Society, and via email communication to SIG members. Interested members volunteered to collaborate as co-authors on this document. Authors divided into subgroups to draft the various sections of the manuscript. Recommendations were reached by consensus first within the subgroups and then all co-authors had the opportunity to read the entire manuscript so that final recommendations could be reached by consensus. The opinions expressed in this manuscript represent those of the co-authors and do not represent the opinion of the American Headache Society.

Headache Characteristics in Children With Pseudotumor Cerebri Syndrome, Elevated Opening Pressure Without Papilledema, and Normal Opening Pressure: A Retrospective Cohort Study: Headache

Certain headache characteristics and associated symptoms are commonly attributed to increased intracranial pressure, but they have not been systematically studied among children in the context of revised diagnostic criteria for pseudotumor cerebri syndrome (PTCS).

Pediatric Pseudotumor Cerebri Syndrome

Patients with pseudotumor cerebri syndrome (PTCS) have elevated intracranial pressure of unclear etiology. This diagnosis requires the presence of normal brain parenchyma on neuroimaging and normal cerebrospinal fluid composition without evidence of infection or neoplasm. PTCS can be a highly morbid complication of obesity; however, the diverse clinical spectrum of pediatric PTCS is becoming increasingly recognized. With appropriate management, the prognosis for vision and other symptoms, such as headache and double vision, is excellent for mild cases; however, patients with more severe disease and progressive vision loss may suffer permanent visual impairment.