Migraine headache in children

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 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.[1]Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2013 Jul;33(9):629-808. https://www.ichd-3.org http://www.ncbi.nlm.nih.gov/pubmed/23771276?tool=bestpractice.com

Diagnostic criteria for children are broader than those used for adults in relationship to both duration and localization of pain. Many affected children do not fit the traditional diagnostic classifications that have been developed from practice in adults.[2]Ryan S. Medicines for migraine. Arch Dis Child Educ Pract Ed. 2007 Apr;92(2):ep50-5. http://www.ncbi.nlm.nih.gov/pubmed/17430855?tool=bestpractice.com This should not exclude them from a trial of acute or prophylactic treatment, provided alternative diagnoses have been carefully excluded. Diagnosis is difficult in young children because the condition is defined by subjective symptoms.