Abstract Details

Title Prophylactic Use of SNRIs to Treat Pediatric Migraine via Reduction of Comorbid Anxiety and Depression

Topic Headache

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-020

Objective This study evaluates if SNRI use in pediatric migraine patients is associated with (1) reduced depression and anxiety symptoms comorbid to migraine and (2) reduced headache severity and headache-related disability.

Background Despite evidence that prophylactic migraine drugs are no better than placebo at reducing number of headache days and headache-related disability in pediatric migraine patients, studies have not considered how prophylactic drugs might affect comorbid conditions; treating conditions comorbid to migraine might improve migraine patient outcomes.

Design/Methods Seventy-nine pediatric patients taking SNRIs for migraine prophylaxis at Johns Hopkins Headache Center (JHHC) were selected for study participation. Participants were sent an online survey identical to a routine survey they completed upon initial visit to JHHC. The survey contained depression, anxiety, and disability (PedMIDAS) screens and questions about headache frequency and severity. Due to non-normal data, Wilcoxon signed-rank tests were used to assess changes in survey responses pretreatment and in-treatment with SNRIs.

Results Thirty participants (27 female, 3 male, mean age=16.5 (SD=2.0)) completed the survey. Wilcoxon signed-rank tests showed a reduction in the following variables: median headache frequency from baseline (Mdn=7 headaches/week) to in-treatment (Mdn=5 headaches/week, p=0.003), pain level during minor headaches from baseline (Mdn=3.5/10) to in-treatment (Mdn=3/10, p=0.04), pain level during average headaches from baseline (Mdn=6/10) to in-treatment (Mdn=5/10, p=0.02), and pain level during severe headaches from baseline (Mdn=9/10) to in-treatment (Mdn=8, p=0.01). Median PedMIDAS score also decreased from baseline (Mdn=68.5) to in-treatment (Mdn=30.5, p=0.01). No significant change was noted for depression and anxiety screening scores.

Conclusions Although SNRI use was associated with improvements in headache severity, frequency, and disability, a reduction in patient anxiety and depression scores was not seen and thus does not appear to be a significant mechanism underlying the observed headache improvement. Future research on SNRIs in migraine patients may elucidate the nature of their effectiveness as a migraine prophylactic.

Authors/Disclosures
Sarah J. McAlister PRESENTER	No disclosure on file
Christopher Oakley, MD (Johns Hopkins Hospital)	Dr. Oakley has nothing to disclose.

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