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Migraine attacks and sleep in children
K Aaltonen1, M L Hämäläinen, K Hoppu
1Hospital for Children and Adolescents, Department of Clinical Pharmacology, University of Helsinki, Finland. kati.aaltonen@fimnet.fi
Insights
Pediatric migraine attacks are intensely painful. Sleep frequently resolves these attacks, particularly in children younger than 8 years old, offering a natural end to migraine episodes.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Pain Management
Background:
- Migraine attacks in children are characterized by severe pain.
- Understanding natural resolution mechanisms for pediatric migraine is crucial for effective management.
Purpose of the Study:
- To investigate the role of sleep in resolving migraine attacks in children aged 4-16 years.
- To analyze the efficacy of sleep in ending migraine based on age groups.
Main Methods:
- A study involving 133 children (4-16 years) in out-patient settings.
- Migraine attacks were recorded in headache diaries, with pain intensity assessed using Visual Analogue Scale (VAS) and a five-face scale.
- Sleep occurrence and attack resolution were documented for 999 migraine attacks.
Main Results:
- Sleep occurred during 33% of migraine attacks, resolving them in 62% of children under 8 years old.
- Pain intensity was high across both scales, with 88% on VAS and 93% on the face scale indicating severe pain.
- Sleep was a more common resolution method in younger children (under 8 years) compared to older age groups.
Conclusions:
- Migraine attacks in children are extremely painful and significantly impact quality of life.
- Sleep serves as a natural and effective resolution mechanism for pediatric migraine, especially in younger children.
- Further research into sleep's role could inform non-pharmacological migraine management strategies for children.
Abstract:
Falling asleep as a means of ending migraine attack was studied in 133 4-16-year-old children in out-patient settings. Children registered 999 migraine attacks in headache diaries using a visual analogue scale (VAS) in 409 attacks and a five-face scale in 590 attacks. The distribution of maximal pain intensity was similar on both scales; on VAS 88% assigned grades between 63 and 100, and on the face scale 93% assigned grades of 4 or 5. Children fell asleep during 33% of the attacks (n = 329), in 64% of these within the first hour (n = 209). Of the children, 68% (n = 91) had fallen asleep at least once during an attack. Falling asleep was more common in children under 8 years of age than in older children. In those under 8 years, 62% (95% confidence interval (CI) 49-75%) of attacks were resolved by sleep, in those aged 8-12 years 34% (26-41%), and in children >12 years 24% (15-33%) (ANOVA, P<0.0001). Pain was relieved without sleep in 43% (n = 431) of attacks, in 38% of these (n = 383) within the first 4 h. The data on migraine resolution were missing for 24% (n = 239) of the attacks, most often because the attack exceeded the 5-h observation period. This study confirms that migraine attacks in children are extremely painful and often resolve during an interval of sleep in children under 8 years of age.