Migraine in children and adolescents

Although migraine has been considered in the past to be uncommon in children and adolescents, there is mounting evidence that it is not, and that it produces significant childhood morbidity. However, the clinical picture varies from case to case, and often from attack to attack in the same patient. Stress plays a most important role in triggering attacks of this familial disease, and the physician must be aware of this if his treatment is to be successful. In adolescent girls, falling estradiol plasma levels are apprently important in triggering attacks of migraine associated with menstruation. In an attack, the initial vasoconstrictive phase, mainly intracranial gives way to a vasodilative phase, mainly extracranial, which results from withdrawal of the vasoconstrictive support from the extracranial arteries which is normally provided by serotonin. The plasma level of the latter drops sharply during an attack, and its excretion product, 5-hydroxy-indole acetic acid, appears in increased amounts in the urine. Laboratory investigations, after a most careful, detailed history, and physical examination, should include an EEG, skull films and possibly a brain scan. Management includes prophylactic measures, both environmental and pharmacologic, and treatment of the attack itself, where promptness is the watchword.