A missed diagnosis that can evolve into lifelong chronic pain
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Experts believe, the consensus is that if we can better treat pediatric migraine, we would have less adults with chronic migraine similarly in the adult population.
—Amaal Starling, MD, neurologist at Mayo Clinic
It’s a condition impacting 10% of children, yet experts say it’s often overlooked. []
Screening for migraine in the pediatric population is crucial for preventing disease progression, but this isn’t happening as frequently as necessary.
“We definitely need to increase screening for migraine at pediatric annual visits," insists Amaal Starling, MD, a neurologist at Mayo Clinic. "This is a disease that's affecting 1 in 10 children. We shouldn't be waiting for them to come to us and telling us about their symptoms. We should actually be proactively screening for the development of migraine… so that we can be better prepared at screening, diagnosing, and eventually treating migraine and reducing the risk of disease progression."
“Experts believe, the consensus is that if we can better treat pediatric migraine, we would have less adults with chronic migraine similarly in the adult population,” Dr. Starling continues.
Few treatment options for pediatric patients
Despite the impact migraine can have on quality of life, there are few FDA-approved therapeutics for the treatment of pediatric migraine.
Children are a vulnerable population... The other thing that's challenging, just across the board, in pain research—and the surprise in migraine and headache disorder research—is that we have a high placebo effect. And interestingly, in children, that placebo effect is even higher.
—Amaal Starling, MD, neurologist at Mayo Clinic
“Even when there were studies that were done looking at our prior preventive medications, like propranolol, amitriptyline, topiramate, comparing that to those medications plus cognitive behavioral therapy versus cognitive behavioral therapy alone, there was actually no difference. And so people thought, well, maybe these medications are ineffective in children, maybe cognitive behavioral therapy is the only thing that's effective. And I don't think it's necessarily that," Dr. Starling continues.
Related: The CGRP playbook migraine experts actually useLack of funding
The lack of research in the pediatric populations speaks to a broader issue in migraine research: lack of funding.
“For migraine being a leading cause of disability worldwide, being the number one leading cause of disability in women aged 15 to 49 specifically in the United States, the amount of National Institute of Health research funding that we get is very low,” Dr. Starling says.
Migraine funding gets about $20 to $25 million per year, Dr. Starling explains, but if you look at other conditions that have the same amount of disease burden as migraine, "we should be getting about $200 to $220 million per year.”
Management barriers to overcome
But Dr. Starling notes there are still many barriers that can prevent adequate management of migraine in the pediatric population, that mirror many of the challenges experienced by adult populations.
“If we can extrapolate from the adult epidemiology data, there are three healthcare barriers that need to be crossed for people to have an optimized treatment regimen," she says. "The first healthcare barrier is talking to a physician about their symptoms. The next is getting the right diagnosis, and the next is getting the right treatment based on the diagnosis of migraine. The biggest drop-off is actually the first one, talking to a doctor about their symptoms. The next biggest drop-off is the diagnosis."
“Interestingly, once people have the diagnosis, they do start coming down that flow chart of treatment options. But awareness and diagnosis are the areas that we need to focus on," she continues.
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