儿童前庭性偏头痛在儿童前庭项目中的药物治疗管理

文献信息

中文摘要

目的： 比较用于治疗儿童前庭性偏头痛的药物的疗效和耐受性。
方法： 这项在四级儿童前庭项目中开展的回顾性分析，依据2021年Bárány学会诊断标准，纳入年龄≤18岁、患有儿童前庭性偏头痛（VMC）、可能VMC或儿童复发性眩晕的患者。预防性药物包括赛庚啶、普萘洛尔、托吡酯、阿米替林、去甲替林、文拉法辛和度洛西汀。补救药物包括曲普坦类、非甾体抗炎药（NSAIDs）和美克洛嗪。收集患者特征。头痛和头晕症状的变化被分类为无改善、轻度改善、明显改善或完全缓解。采用广义估计方程比较每种药物达到至少明显改善的患者比例。
结果： 共纳入160例患者[平均（SD）年龄12.8（3.9）岁；70%为女性]。在预防性药物中，达到至少明显改善的患者比例以托吡酯最高，并且在头晕（67.6% vs. 37.5%，p < 0.001）和头痛（69.4% vs. 37.5%，p < 0.001）方面，与表现最低的赛庚啶相比存在显著差异。在补救药物中，曲普坦类在头晕（40.0% vs. 12.5%，p = 0.048）和头痛（42.7% vs. 5.6%，p = 0.019）方面优于美克洛嗪，并在头晕方面优于NSAIDs（40.0% vs. 11.5%，p = 0.021）。年龄、性别、焦虑、抑郁或脑震荡史均未影响任何药物的治疗结局。
结论： 对于儿童前庭性偏头痛的预防，托吡酯在头晕和头痛方面显示出更优的改善，且耐受性可接受。曲普坦类在补救药物中表现最佳。这突出表明托吡酯可作为潜在的一线预防用药，并支持使用曲普坦类治疗儿童前庭性偏头痛发作。

英文摘要

OBJECTIVE: To compare the efficacy and tolerability of medications used to treat pediatric vestibular migraine.
METHODS: This retrospective analysis at a quaternary pediatric vestibular program identified patients ≤18 years old with vestibular migraine of childhood (VMC), probable VMC, or recurrent vertigo of childhood per the 2021 Bárány Society diagnostic criteria. Preventative medications included cyproheptadine, propranolol, topiramate, amitriptyline, nortriptyline, venlafaxine, and duloxetine. Rescue medications included triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), and meclizine. Patient characteristics were obtained. Changes in headache and dizziness symptoms were classified as no improvement, minor improvement, major improvement, or complete resolution. Generalized estimating equations compared the proportion of patients with at least major improvement for each medication.
RESULTS: 160 patients were included [mean (SD) age 12.8 (3.9) years; 70% female]. Among preventatives, the proportion of patients who experienced at least major improvement was greatest for topiramate, with a significant difference relative to the lowest performer, cyproheptadine, for dizziness (67.6% vs. 37.5%, p < 0.001) and headache (69.4% vs. 37.5%, p < 0.001). Among rescue medications, triptans outperformed meclizine in dizziness (40.0% vs. 12.5% p = 0.048) and headache (42.7% vs. 5.6%, p = 0.019), and outperformed NSAIDs in dizziness (40.0% vs. 11.5%, p = 0.021). Age, sex, anxiety, depression, or concussion history did not influence treatment outcomes for any medication.
CONCLUSIONS: For pediatric vestibular migraine prevention, topiramate showed superior improvement in dizziness and headache with acceptable tolerability. Triptans performed the best among rescue medications. This highlights topiramate as a potential first line preventative and supports triptans in treating pediatric vestibular migraine attacks.