Occipital Nerve Blocks for Acute Treatment of Pediatric Migraine

Szperka博士是费城儿童医院的头痛专家和流行病学家。她之前的工作主要集中在队列研究中，研究头痛的特征和难以治疗的头痛患者的结果。她的长期目标是开发头痛治疗研究的新方法，以改善对治疗无效的患者的护理。这项资助将把之前的观察工作与长期目标联系起来，使她能够进行有指导的研究，学习临床试验方法和统计学，成为一名独立资助的临床试验学家。研究：偏头痛是儿童中一种非常普遍且致残的头痛疾病，但20- 30%的儿童偏头痛患者对现有的治疗方法难以治愈。试验设计问题，包括高安慰剂反应率和可能的受试者分离，一直是证明疗效的主要障碍。本提案将(1)通过一项连续试验设计测试利多卡因更大程度枕神经阻滞对急性偏头痛儿童/青少年的疗效，(2)测试利多卡因乳膏是否会使受试者对利多卡因和生理盐水注射失明，以及(3)检查感知治疗、预期获益和疼痛减轻之间的关系。这些研究将为更有效的偏头痛试验奠定基础。环境和职业发展：Szperka博士沉浸在丰富的支持中，这将促进她的职业发展。费城儿童医院和宾夕法尼亚大学是她三位导师的家。Farrar， plugos和Hsu以及临床流行病学和生物统计中心。此外，Szperka博士的职业生涯将继续得到头痛医学同事的帮助，最著名的是她的二级顾问Hershey博士，杰斐逊头痛中心的奖学金导师，以及美国头痛协会的领导。Szperka博士的指导团队在NIH资助的临床研究方面拥有丰富的经验，培训成功的独立研究人员的历史，以及对Szperka博士职业生涯的坚定承诺。专家指导、深厚的临床研究基础设施和多地点试验的培训相结合，将使Szperka博士成为一名临床试验专家，他将推动偏头痛试验设计。

Dr. Szperka is a headache specialist and epidemiologist at the Children's Hospital of Philadelphia. Her prior work has focused on cohort studies examining headache characteristics and outcomes in patients with difficult-to-treat headaches. Her long-term goal is to develop novel approaches to studies of headache therapies to improve care for patients who are ineffectively treated. This grant will bridge prior observational work to that long-term goal, enabling her to conduct mentored research, and study clinical trial methodology and statistics to become an independently funded clinical trialist. Research: Migraine is a highly prevalent and disabling headache disorder in children, but 20- 30% of children with migraine are refractory to the available therapies. Trial design problems, including high placebo response rate and possible unbinding of subjects, have been major hurdles to proving efficacy. This proposal will (1) test efficacy of greater occipital nerve blocks with lidocaine in children/adolescents with acute migraine using a run-in trial design, (2) test whether lidocaine cream can blind subjects to lidocaine vs. saline injection, and (3) examine the relationship between perceived treatment, expectation of benefit, & pain reduction. These studies will lay the foundation for more efficient migraine trials. Environment and Career Development: Dr. Szperka is immersed in a rich tapestry of support which will promote her career development. The Children's Hospital of Philadelphia and the University of Pennsylvania are the homes for 3 of her mentors, Drs. Farrar, Dlugos, and Hsu, and the Center for Clinical Epidemiology and Biostatistics. In addition, Dr. Szperka's career will continue to be aided by colleagues in Headache Medicine, most notably her secondary advisor, Dr. Hershey, fellowship mentors from the Jefferson Headache Center, and the leadership of the American Headache Society. Dr. Szperka's mentoring team has extensive experience in NIH- funded clinical research, a history of training successful independent researchers, and a strong commitment to Dr. Szperka's career. The combination of expert mentorship, a deep clinical research infrastructure, and training in multi-site trials will mold Dr. Szperka into a clinical trialist who will advance trial design in migraine.