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Published on: June 2, 2014
Migraine in the pediatric population--evolving concepts
Marcelo E Bigal1, Marco A Arruda
1Office of the Chief Medical Officer-Merck inc. Upper Gwynedd, PA, USA.
Insights
Pediatric migraine is common in children and adolescents. Current diagnostic criteria may be too strict for young children, and early life exposures could influence migraine progression.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Headache research is crucial across all age groups, particularly in pediatrics.
- Understanding early childhood headaches is less advanced than in adolescents.
- Epidemiological studies are vital for understanding headache prevalence and determinants.
Purpose of the Study:
- To provide a theoretical framework for understanding pediatric headaches.
- To summarize findings from an epidemiological study on pre-adolescent headaches.
- To explore factors influencing migraine progression in children.
Main Methods:
- Review of current understanding of pediatric headaches.
- Analysis of data from a large, ongoing epidemiological study in pre-adolescent children.
- Examination of potential risk factors including family history and prenatal exposures.
Main Results:
- Migraine is frequent in both pre-adolescents and adolescents.
- Existing diagnostic criteria for migraine and chronic migraine may be inappropriate for young children.
- Migraine episodes in young children often last less than one hour.
- A subset of children is at risk for migraine progression, influenced by genetics and early life exposures.
- Family history of headaches and prenatal exposures are relevant risk factors.
- Migraine is associated with behavioral hyperactivity but not attention-deficit/hyperactivity disorder.
Conclusions:
- Migraine is a significant issue in pre-adolescent children, requiring tailored diagnostic approaches.
- Early life factors, including prenatal exposures and family history, play a role in migraine development and progression.
- Further research is needed to refine diagnostic criteria and understand the pathophysiology of pediatric migraine.
Abstract:
Studying the prevalence of headaches at age extremes is of important clinical relevance. Pediatric studies inform us about determinants of incident disease; studies of elderly populations inform us about the long-term consequences of headaches, as well as about determinants of headache remission. As with other subspecialties of headache research, research on pediatric headache is an evolving field. However, although substantial advances have been achieved in understanding headaches in adolescents, knowledge of early childhood headaches is not as advanced conceptually. This review provides a theoretical framework for our current understanding, then summarize the results of a large, ongoing, epidemiological study in pre-adolescent children. It is clear that both in adolescents and in pre-adolescents, migraine is frequent. Diagnostic criteria for migraine and chronic migraine are certainly over-restrictive for young children. Migraine often lasts less than 1 hour in young children. A vulnerable population at risk of migraine progression also exists, likely reflecting increased biological predisposition, but also early life exposures. Indeed, it seems that even prenatal exposures of certain substances may increase the risk of migraine progression. Of relevance is the frequency of headaches within a family. Finally, migraine seems to be associated with behavioral hyperactivity, but is not comorbid with attention-deficit disorder and hyperactivity.
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