Neurologists Find Effective Drug for Treating Children with Daily Headaches

Severe daily headaches in children can have a significant impact on their entire family, quality of life, academic performance and social activity. They've been difficult to treat because they don't respond well to conventional therapy. Now pediatric neurologists from Doernbecher Children's Hospital have found that a drug used to treat migraines in adults and children can also reduce the frequency and severity of daily headaches in children. The study results were presented this week at the annual meeting of the American Academy of Neurology in San Francisco.

"Finally we have something that will make a significant impact in an otherwise challenging and difficult to treat patient population," said Thomas Koch, M.D., director of pediatric neurology at Doernbecher Children's Hospital, professor of pediatrics and neurology at the OHSU School of Medicine, and study author. "This will allow us to offer these children some relief that has been really hard to obtain prior to the use of this drug."

Koch and his team found that 62 percent of families in the study reported that low doses of topiramate (Topamax ®), a new anti-seizure drug, was successful in reducing both the frequency and severity of headache episodes. The frequency decreased from 22.8 headaches per month to 7.2. While severity decreased from a pain score of 8.1 (10 being intense pain and 1 low pain) to 3.7.

A study published in the February 2004 issue of the Journal of the American Medical Association showed that topiramate was effective in preventing migraines in adults and children. Koch and his team took the use of the drug one step further by studying whether this drug at lower doses could also be effective in treating a very difficult subset of migraines known as chronic daily headaches. This is the first study to look only at children under 18 with chronic daily headaches rather than at all ages of patients with all types of migraines.

Doernbecher's study of 21 patients, ages 6 to 18, found that 50 milligrams or less of topiramate was effective in treating these complex headaches rather than the higher dose used to treat migraines. Higher doses have caused side effects in some patients. Koch's team reviewed the medical records of all these patients whose parents had completed a questionnaire providing feedback on headache frequency and severity before their children used topiramate and after at least one month of therapy.

Approximately 4 to 10 percent of children suffer from migraines, according to The American Council for Headache Education. Chronic daily headaches are those that occur more than 15 times per month. The pain is nearly always present, but the intensity may fluctuate throughout the day and may be on the top, sides or back of the head.

Annette Calcagno of Troutdale, Ore., knows all too well the impact of daily headaches on children and their families. Her 3-year-old son Anthony Calcagno, Jr. used to scream every day, "Mommy my head hurts so bad. Make it stop." It was so intense he would bang his head on the floor. For almost two years he suffered from chronic daily headaches five to six days a week. Since he started taking Topamax®) December 2003 he hasn't had any headaches.

"It was so hard to see him in pain. Now even his teachers have told me he is a completely different boy in school," said Annette.

Daily intense headaches are usually more difficult to treat than common migraines and can lead to school absence, decreased extracurricular activity and loss of work for parents.

"I treat many children with various types of headaches, and there is no question that the most challenging are the chronic daily headaches," said Koch.

Most children with chronic daily headaches see many physicians and try several medications in an effort to find effective treatment. Most medications used to treat this condition provide variable relief for a short time. The exact mechanism of pain with chronic daily headache is poorly understood but probably is related to sensitization of central pain pathways in the brainstem.

Topamax® appears to work by stabilizing the pain pathway through a number of different mechanisms that cause headaches.

This pilot-like study is just the first step, Koch said. Now a larger multi-center study should continue to evaluate the effectiveness of this drug as more centers use it to treat children who suffer from chronic daily headaches.

The other authors on the study are John Borzy, research associate in pediatrics at the OHSU School of Medicine, and James Schimschock, M.D., pediatric neurologist at the OHSU Child Development and Rehabilitation Center.

Doernbecher Children's Hospital provides the region's widest range of children's health care services and is the primary center for Oregon Health & Science University's pediatric programs. As part of OHSU, Oregon's only health and research university, Doernbecher offers patients outstanding primary care and access to cutting-edge treatments. More than 200 pediatric specialists at Doernbecher care for 40,000 children each year from Oregon and surrounding states.

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