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Migraine in children and adolescents
Acta Paediatrica Scandinavica. Supplement
|January 1, 1975
Summary
Migraine is increasingly recognized as a significant cause of childhood illness, often triggered by stress. Understanding the varying clinical presentations and underlying mechanisms, such as hormonal changes and serotonin levels, is crucial for effective treatment.
Area of Science:
- Neurology
- Pediatrics
- Clinical Medicine
Background:
- Migraine, once thought rare in children and adolescents, is now recognized as a significant cause of childhood morbidity.
- The clinical presentation of migraine can vary significantly between individuals and even within the same patient during different attacks.
Purpose of the Study:
- To highlight the prevalence and impact of migraine in pediatric populations.
- To elucidate the triggers and pathophysiological mechanisms of migraine attacks in adolescents.
- To outline current diagnostic and management strategies for childhood migraine.
Main Methods:
- Review of existing evidence on pediatric migraine prevalence and clinical features.
- Analysis of proposed triggers, including stress and hormonal fluctuations (e.g., estradiol levels in adolescent girls).
- Description of the proposed pathophysiology involving intracranial vasoconstriction followed by extracranial vasodilation linked to serotonin withdrawal.
- Discussion of diagnostic tools such as electroencephalogram (EEG), skull films, and brain scans.
- Outline of management approaches including prophylactic and acute treatments.
Main Results:
- Migraine is not uncommon in children and adolescents and contributes to significant morbidity.
- Stress is a key trigger for migraine attacks in this population.
- Falling estradiol levels appear to trigger menstrual-associated migraine in adolescent girls.
- Migraine attacks involve an initial intracranial vasoconstrictive phase followed by an extracranial vasodilative phase due to reduced serotonin support.
- Elevated urinary 5-hydroxy-indole acetic acid suggests increased serotonin turnover during attacks.
Conclusions:
- Migraine is an important health concern in children and adolescents requiring physician awareness.
- Effective management necessitates identifying triggers like stress and understanding the disease's pathophysiology.
- A comprehensive approach involving environmental and pharmacological prophylaxis, alongside prompt acute treatment, is recommended.