Migraine headache in the infant and young child
Related Experiment Videos
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
Insights
Pediatric migraine can begin in infancy, presenting with headache and irritability. Early diagnosis and treatment with medications like amitriptyline are effective and safe for young children.
Area of Science:
- Pediatrics
- Neurology
Background:
- Migraine is a common diagnosis in school-aged children, but infrequently described in infants and preschool-aged children.
- Previous studies on early-onset migraine have been primarily retrospective.
Observation:
- This study prospectively evaluated six children aged 5-42 months diagnosed with migraine.
- Four children met Prensky's criteria for migraine; the two youngest presented with ophthalmoplegic migraine.
- All participants had a strong family history of migraine and exhibited symptoms like headache, facial pallor, irritability, sleep disturbances, and mood changes.
Findings:
- Four older children responded well to low-dose amitriptyline or imipramine.
- The youngest infants with ophthalmoplegic migraine showed incomplete response to therapy.
- Follow-up at 2-18 months showed all children were well, with no reported toxicity.
Implications:
- Pediatricians should consider migraine as a diagnosis in infants and very young children.
- Early migraine diagnosis and treatment can be safe and effective in this population.
- Further research into ophthalmoplegic migraine in infants is warranted.
Abstract:
Migraine is a common clinical diagnosis, occurring in 4-10% of school age children. Migraine in the infant and preschool child has been infrequently described in retrospective studies. We report the prospective evaluation and therapy of six children (5-42 months) with migraine. In four of the children, Prensky's criteria were used for diagnosis, while the two youngest children presented with ophthalmoplegic migraine. All children had a strong family history of migraine and presented with headache and prominent features including facial pallor, irritability, sleep disturbance or mood changes. The oldest four children were successfully treated with either amitriptyline or imipramine in low doses. The infants with ophthalmoplegic migraine failed to completely respond to any therapy. At followup 2 to 18 months later, all children were well and without toxicity. The pediatrician should be aware that migraine may begin in infancy and can be effectively and safely treated.