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Migraine in children

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Migraine is a diagnosis of exclusion in children, characterised by recurrent, paroxysmal, symptom-free intervals, with no organic or psychogenic features. Before a firm diagnosis is made, the patient should be watched for long enough to ensure that growth is normal. Proper recognition would lead to diagnosis within four months in 96% of cases.

Features of migraine in children:

  • occurs in all age groups, even younger than 5 years (1)
  • migraine has a 1-year prevalence of about 7% among school-age children (2)
  • migraine occurs in 3% to 10% of children and increases with age up to puberty (3)
  • migraine affects boys and girls similarly before puberty, but girls are more likely to suffer from migraine afterwards (3)
  • migraine spontaneously remits after puberty in half of children, but if it begins during adolescence, it may be more likely to persist throughout adulthood (3)
  • variable frequency of attacks, 20% have 2 to 3 attacks per week (1)
  • variable duration however the majority are less than 5 hours(1)
  • children experience all the different types of migraine:
    • hemianopic aura are rarer
    • vertebrobasilar syndromes more common
  • first degree relatives of subjects with migraine have a 1.9 times higher risk of developing migraine compared to the general population and the concordance rate for migraine with aura in monozygotic twins is 34% compared to 12% in dizygotic twins (4)
  • suffer from all the different types of migraine

The underlying cause of migraine is unknown (1). However in some children the condition has been associated with various factors (1):

  • insufficent food
  • specific foods e.g. cheese, chocolate, citrus fruits
  • alcohol
  • dehydration
  • caffeine
  • overuse of analgesia
  • lack of sleep or excess sleep
  • flickering or bright lights e.g. television, computer screen
  • stress
  • illness
  • minor head trauma
  • travel
  • in girls after the menarche - menses or taking the oral contraceptive pill

With respect to migraine prophylaxis in children a review states (5):

  • propranolol was found to be possibly effective in reducing migraine frequency by 50% compared with placebo
  • topiramate and cinnarizine (not available in the US or Canada) were possibly associated with reduced frequency of headache compared with placebo

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

Reference

  1. Drug and Therapeutics Bulletin 2004; 42 (4): 25-8.
  2. Ashina M. Migraine. N Engl J Med 2020;383:1866-76. DOI: 10.1056/NEJMra1915327
  3. Barnes NP. Migraine headache in children. BMJ Clin Evid. 2011; 2011: 0318
  4. Spiri D et al. Pediatric migraine and episodic syndromes that may be associated with migraine. Ital J Pediatr. 2014; 40: 92.
  5. Hovaguimian A, Roth J. Management of chronic migraine BMJ 2022; 379 :e067670 doi:10.1136/bmj-2021-067670

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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