American Society of Regional Anesthesia and Pain Medicine November 2017 - 27

migraine medication. Following the crossover period, all patients will
proceed to an open-label treatment phase with OBTA.

REFERENCES
1.

Jacobs H, Gladstein J. Pediatric headache: a clinical review. Headache
2012;52(2):333-339. doi: 10.1111/j.1526-4610.2011.02086.x

FUTURE DIRECTIONS
We have begun our journey to deliver better relief to children in
pain, and we, as investigators and physicians, have gathered new
insight into the success of nontraditional thinking for sustainable
pain relief in this vulnerable population. More specifically, we
discovered that the general pediatric community as well as patients
and families welcomed this experimental and investigational option
more warmly than traditional methods of treating migraine pain-
reminding us why we physicians continually pursue research so
enthusiastically. We learned (through a very arduous process) that
performing clinical trials in the pediatric population-even more
so in the pediatric pain population-is trenched with bureaucratic
protocols and processes; however, based on our early data, it was
well worth the struggle. Ultimately, our overriding rationale is to
demonstrate efficacy, tolerability, and safety of OBTA for pediatric
migraine, thereby potentially hastening the lengthy process to
evaluate OBTA for approval in the pediatric population. The most
urgent goals for pharmaceutical innovation are the development
of pathomechanism-based antimigraine drugs and personalized
therapy tailored to children and adolescents experiencing migraines.

Hershey AD, Powers SW, Coffey CS, Eklund DD, Chamberlin LA, Korbee LL.
Childhood and Adolescent Migraine Prevention (CHAMP) study: a double-blinded,
placebo-controlled, comparative effectiveness study of amitriptyline, topiramate,
and placebo in the prevention of childhood and adolescent migraine. Headache
2013;53(5):799-816. doi: 10.1111/head.12105

Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive
time and cost due to common pain conditions in the US workforce. JAMA
2003;290:2443-2454. doi: 10.1001/jama.290.18.2443

Delgado MR, Hertz D, Aisne M, et al. Practice parameter: pharmacologic
treatment of spasticity in children and adolescents with cerebral palsy (an
evidence-based review): report of the Quality Standards Subcommittee
of the American Academy of Neurology and the Practice Committee of
the Child Neurology Society. Neurology 2010;74:336-343. doi: 10.1212/
WNL.0b013e3181cbcd2f

Aurora SK, Winner P, Freeman MC, et al. OnabotulinumtoxinA for treatment of
chronic migraine: pooled analyses of the 56-week PREEMPT clinical program.
Headache 2011;51(9):1358-1373. doi: 10.1111/j.1526-4610.2011.01990.x

Dodick DW, Turkel CC, DeGryse RE, et al. OnabotulinumtoxinA for treatment of
chronic migraine: pooled results from the double-blind, randomized, placebocontrolled phases of the PREEMPT clinical program. Headache 2010;50(6):921-
936. doi: 10.1111/j.1526-4610.2010.01678.x

Ahmed K, Oas KH, Mack KJ, Garza I. Experience with botulinumtoxin type
A in medically intractable pediatric chronic daily headache. Pediatr Neurol
2010;43:316-319. doi: 10.1016/j.pediatrneurol.2010.06.001

Chan V, McCabe EJ, MacGregor, DL. Botox treatment for migraine and chronic
daily headache in adolescents. J Neurosci Nurs 2009;41(5):235-243.

Kabbouche M, O'Brien H, Hershey, AD. OnabotulinumtoxinA in pediatric chronic
daily headache. Curr Neurol Neurosci Rep 2012;12(2):114-117. doi: 10.1007/
s11910-012-0251-1

ACKNOWLEDGMENTS
We wholeheartedly thank ASRA and the Committee on Research
for its generous support, guidance, and enthusiasm in supporting
the study of migraine pain in children. We thank our team for
its endless commitment and late-night meetings, as well as
our patients for taking the journey with us towards discovery.
We hope our work will be a springboard for future physicians to
develop a contribution to pediatric migraine, and we welcome all
opportunities for collaboration.

10. Schroeder AS, Huss K, Blaschek A, et al. Ten-year follow-up in a case series
of integrative botulinum toxin intervention in adolescents with chronic daily
headache and associated muscle pain. Neuropediatrics 2012;43(6):339-345.
doi: 10.1055/s-0032-1329612

American Society of Regional Anesthesia and Pain Medicine
2017

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