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Natural history of migraine in childhood
M A Hernandez-Latorre1, M Roig
1Child Neurology Unit, Hospital de Niños de Barcelona, Spain.
Insights
Most childhood migraine patients experience a favorable outcome, but early onset predicts a poorer prognosis. Genetic factors significantly influence migraine development in children.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Migraine affects 3-7% of children, yet its natural history and prognosis are poorly understood.
- Limited research exists on the long-term clinical evolution of pediatric migraine.
Purpose of the Study:
- To describe the natural history of childhood migraine.
- To identify early predictors of unfavorable clinical outcomes in pediatric migraine patients.
Main Methods:
- A 10-year prospective, longitudinal follow-up study of 181 pediatric migraine patients.
- Statistical analysis using significance tests and logistic regression.
Main Results:
- The majority (88%) of pediatric migraine patients showed a favorable clinical course.
- Early age of onset (before age 10) was the sole significant predictor of an unfavorable prognosis.
- A positive family history of migraine was present in 77.5% of cases.
Conclusions:
- Most childhood-onset migraines do not necessitate prophylactic treatment.
- Earlier disease onset correlates with a higher likelihood of an unfavorable clinical course.
- Genetic factors are crucial in pediatric migraine; distinct patient subgroups may exist.
Abstract:
Epidemiological studies have shown that 3-7% of the paediatric population suffer from migraine. Despite this high prevalence little has been published about the natural history of migraine or of its prognosis. The objectives of this study were: (i) to outline the natural history of migraine in childhood; and (ii) to identify early predictors of an unfavourable clinical evolution. A prospective, longitudinal, 10-year follow-up study was conducted of the clinical evolution of 181 paediatric patients with migraine. Data analysis was performed by statistical significance and logistic regression tests. In our study 24.3% of children with migraine had their onset before age 6 years and another 57% between 6 and 10 years of age. A positive family history of migraine was recorded in 77.5%. Eighty-eight percent of patients followed a favourable clinical course. The remaining 12% of patients had to be placed on prophylactic treatment owing to the increasing of their headache. Of all parameters investigated, the age of onset was the only statistically significant predictor of an unfavourable clinical evolution. We conclude: (i) most patients with migraine headache starting in childhood do not require prophylactic treatment; (ii) the earlier the disease begins the more likely is an unfavourable clinical course; (iii) genetic factors play an important role in the phenotypic expression of the disease; (iv) our study suggests the existence, at least, of two different populations among childhood migraine patients.