Migraine headache in children

Migraine is a common neurologic disorder that often starts in childhood and teenage years, and leads to significant morbidity, emergency department visits, and school absenteeism.

Recurring, moderate to severe headaches associated with nausea and with light and noise sensitivity, with a complete return to baseline in between the attacks, are characteristic of migraine.

The diagnosis remains clinical, based on a suggestive history and a normal neurologic exam. When evaluating a child or adolescent with a headache, carefully considering differential diagnoses is essential to rule out serious causes.

Treatment is often individualized and multifaceted. Judicious use of preventive and abortive drugs coupled with migraine education, lifestyle adjustments, and trigger avoidance are the mainstay of treatment.

Pediatric migraine is a chronic neurologic disorder with a strong genetic component characterized by episodic, moderate to severe attacks of headache and other accompanying symptoms such as nausea, vomiting, and sensitivity to light and noise. Functional impairment during attacks is common, as is a return to normal between attacks. Onset occurs at any time during childhood and adolescence.

The International Headache Society (IHS) defines migraines as recurrent headaches that occur with or without aura and last for 2-72 hours. They are unilateral or bilateral in location, of gradual onset (over 15-30 minutes), pulsating in character, and of moderate to severe intensity. They are aggravated by routine physical activity. Nausea, vomiting, photophobia, and phonophobia are common accompanying symptoms.[1]Headache Classification Committee of the International Headache Society. The international classification of headache disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. https://www.ichd-3.org/wp-content/uploads/2018/01/The-International-Classification-of-Headache-Disorders-3rd-Edition-2018.pdf http://www.ncbi.nlm.nih.gov/pubmed/29368949?tool=bestpractice.com

The IHS diagnostic criteria for pediatric headache are limited because they rely on patient descriptions of symptoms, whereas in practice, many migraine-defining features (e.g., light or noise intolerance) are inferred from child behavior rather than reported.[2]Özge A, Faedda N, Abu-Arafeh I, et al. Experts' opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents. J Headache Pain. 2017 Nov 23;18(1):109. https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-017-0818-y http://www.ncbi.nlm.nih.gov/pubmed/29285570?tool=bestpractice.com