Diagnosis of childhood migraine

• assessment of a child with a headache is mainly clinical - radiological imaging is rarely required
• history of the headache should assess:
  • nature and quality of pain
  • intensity of pain
  • site and spread of pain
  • frequency and duration of headache
  • associated symptoms
  • trigger or predisposing factors
  • aggravating and relieving factors
• ideally a full neurological examination should be undertaken - including visual field testing and fundoscopy
• growth, blood pressure and visual acuity should be assessed

In general, neurological examination and investigations reveal no abnormalities in children with migraine (1).

Indications for imaging include:

• abnormal neurological findings - especially if accompanied by nystagmus, papilloedema or gait or motor abnormalities
• headaches that repeatedly wake a child from sleep or occur immediately on awakening
• persistent headache associated with substantial episodes of confusion, vomiting or disorientation
• also "imaging is also probably worth carrying out in children whose symptoms develop before the age of 5 years "

Note: migraine is approximately 50% more likely in relatives of people with the condition than in those whose relatives do not have migraine.

Reference:

1. Szperka C. Headache in Children and Adolescents. Continuum (Minneap Minn). 2021 Jun 01;27(3):703-731.