childhood migraine

Last edited 10/2022 and last reviewed 10/2022

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