Migraine in the Pediatric Population—Evolving Concepts

Abstract

Studying the prevalence of headaches at age extremes is of important clinical relevance. Pediatric studies inform us about determinants of incident disease; studies of elderly populations inform us about the long-term consequences of headaches, as well as about determinants of headache remission. As with other subspecialties of headache research, research on pediatric headache is an evolving field. However, although substantial advances have been achieved in understanding headaches in adolescents, knowledge of early childhood headaches is not as advanced conceptually. This review provides a theoretical framework for our current understanding, then summarize the results of a large, ongoing, epidemiological study in pre-adolescent children. It is clear that both in adolescents and in pre-adolescents, migraine is frequent. Diagnostic criteria for migraine and chronic migraine are certainly over-restrictive for young children. Migraine often lasts less than 1 hour in young children. A vulnerable population at risk of migraine progression also exists, likely reflecting increased biological predisposition, but also early life exposures. Indeed, it seems that even prenatal exposures of certain substances may increase the risk of migraine progression. Of relevance is the frequency of headaches within a family. Finally, migraine seems to be associated with behavioral hyperactivity, but is not comorbid with attention-deficit disorder and hyperactivity.

The McMaster Pediatric Migraine Questionnaire: A Prospective Validation Study

“…[6][7][8] In spite of these adjustments, the diagnosis of pediatric migraine remains difficult as children may not be able to describe their headache features in a clinical setting. 1,[9][10][11] The diagnosis of migraine specifically depends on a child's or a parent's ability to recall and communicate his or her symptoms at the time of clinical assessment. 11 Furthermore, a sizable number of children have migrainous headaches lasting <1 hour, which based on current ICHD-II criteria could lead to under recognition of pediatric migraine.…”

Specific Triggers of Migraine Headache in Adolescents

“…Family and twin studies show that there is a genetic component to migraine, but no genes predisposing to common forms of the disorder have been identified, and the actual types of responsible genes are still not fully understood [4]. No empirical study has explicitly examined how genetic and environmental factors influence the adolescent's migraine headache [5,6].…”

Recent developments in the treatment of migraine in children and adolescents

“…However, as has been said "children are not little adults". This led to the eventual definitions for children being modified [2] to more accurately represent the disorder in this age group. In both age groups a complication of migraine, chronic migraine may occur and may influence treatment choices.…”