Challenges in Treating Pediatric Migraine: Christina Szperka, MD, MSCE

WATCH TIME: 5 minutes

“Figuring out what’s first-line might be a really important next step. The cognitive behavioral therapy studies have, I think, pretty clearly shown that if you don’t benefit from a medication as your first-line, and you add on cognitive behavioral therapy as your second-line therapy, there’s clear evidence of benefit."

The absence of a clearly effective first-line treatment for children with migraine is an issue within the space, with the results of the 2017 Childhood and Adolescent Migraine Prevention trial (NCT01581281) being interpreted differently by practitioners. Christina Szperka, MD, MSCE, director of the Pediatric Headache Program at the Children’s Hospital of Philadelphia, discussed this issue, noting the different approaches experts may take, whether it is prescribing medications or opting for nutraceuticals as the first-line treatment. Cognitive behavioral therapy has also shown benefit for patients who may not benefitted from medication, she said, adding that key area of focus is helping children with refractory headache. 

Further discussing adherence in this patient population with NeurologyLive^®, Szperka said it is often less of an issue in younger children and more present as teenagers get older. For older patients, it is important that they drive the conversation, as opposed to their parents, in order to develop independent management of their condition. Additionally, explaining realistic expectations for medications is vital, ensuring that patients understand it may take 6 to 8 weeks to see a benefit. If that conversation is not had, patients may take a medication for 2 weeks, stop taking it when they do not experience improvement, and not return to see the practitioner, thus creating a missed opportunity, Szperka said.