Migraine has a high prevalence in children (10%) and is a significant source of morbidity.
Careful consideration of the broad differential diagnosis is important when evaluating a child with headache.
The expectations for the success of treatment should take account of the level to which psychological factors are contributing to symptoms.
Not all treatments (acute or prophylactic) work for every patient.
Spontaneous remission with increasing age may occur in 25% to 50% of children.
Migraine is defined by the International Headache Society as a recurrent headache that occurs with or without aura and lasts for 2 to 48 hours. It is usually unilateral in nature, of gradual onset (15 to 30 minutes), pulsating in quality, of moderate or severe intensity, and is aggravated by routine physical activity. Nausea, vomiting, photophobia, and phonophobia are common accompanying symptoms.
Diagnostic criteria for children are broader than those used for adults in relationship to both duration and localisation of pain. Many affected children do not fit the traditional diagnostic classifications that have been developed from practice in adults. This should not exclude them from a trial of acute or prophylactic treatment, provided that alternative diagnoses have been carefully excluded. Diagnosis is difficult in young children because the condition is defined by subjective symptoms.
History and exam
Key diagnostic factors
- presence of risk factors
- age >2 years
- gradual onset of headache
- normal physical examination
Other diagnostic factors
- nausea and/or vomiting
- visual disturbance
- occipital headache, ataxia, diplopia, blurred vision, vertigo, and tinnitus
- unilateral motor or sensory signs and headache
- generalised seizure
- positive family history of migraine
- chocolate, cheese, and citrus fruits
- hormonal changes
- alcohol and caffeine
- volume depletion
- overuse of analgesics
- sleep disturbance
- bright or flickering lights
- periodic syndromes
1st investigations to order
- no initial test
Investigations to consider
- brain CT/MRI
frequency and severity of attack has an impact on quality of life and school attendance
- Cluster headache
- Tension headache
- Post-traumatic headache
- Headaches in over 12s: diagnosis and management
- Practice guideline update: pharmacologic treatment for pediatric migraine prevention
Migraine in children
Migraine in children: medicines to prevent attacksMore Patient leaflets
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