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Headache in childhood
1Department of Pediatrics, University of Milan, Italy.
Insights
Pediatric migraine involves recurrent headaches, often with nausea and abdominal pain. While the cause is unknown, stress is a common trigger, and the prognosis is generally good with appropriate treatment.
Area of Science:
- Neurology
- Pediatrics
Background:
- Migraine in children is characterized by recurrent headaches, distinct from other intracranial diseases.
- The exact pathogenesis of pediatric migraine remains unclear, with potential differences between migraine with and without aura.
- Psychological stress is identified as the most frequent trigger for migraine attacks in school-aged children.
Purpose of the Study:
- To outline the diagnostic criteria and clinical characteristics of migraine in children.
- To discuss the potential triggers and varied presentations of pediatric migraine.
- To highlight the diagnostic approach, including exclusion of symptomatic headaches and the role of investigations.
Main Methods:
- Clinical diagnosis based on recurrent headache episodes with free intervals, excluding intracranial pathology.
- Evaluation of common migraine symptoms in children, including headache, nausea, vomiting, abdominal pain, and paresthesias.
- Consideration of complex migraine presentations, basilar artery migraine, and acute confusional states.
Main Results:
- Pediatric migraine attacks commonly feature hemicranial headaches, nausea, vomiting, abdominal pain, and paresthesias; scotomata are less frequent.
- Electroencephalogram (EEG) abnormalities are common, and cerebrospinal fluid (CSF) pleocytosis may occur in complex migraine.
- The prognosis for pediatric migraine is generally favorable, with preventive treatment indicated for severe or refractory attacks.
Conclusions:
- Migraine is the most common cause of recurrent headaches in children, often diagnosed clinically.
- While generally benign, severe or complex cases may require further investigation and preventive strategies.
- Differentiating migraine from symptomatic headaches is crucial, sometimes necessitating laboratory examinations.
Abstract:
Migraine in children is diagnosed in presence of paroxystic episodes of headache which recur with free intervals, provided intracranial diseases are excluded. Pathogenesis of this disorder is unclear; migraine with and migraine without aura may be different entities. Many factors can precipitate a migraine attack. In school age, psychologic stress is the commonest factor. Main characteristics of attacks in children are headache, which may be hemicranial; nausea and vomiting, abdominal pain, paraesthesiae. Scotomata are not very common in the pediatric age. In some cases, migraine attacks are complicated by sensory or motor symptoms (paraesthesiae, paresis), usually at one hemisoma. In the basilar artery migraine syndrome, features of brain-stem dysfunction predominate. In a few patients a migraine attack presents itself as an acute confusional state. In migraine, EEG abnormalities are frequent (predominance of diffuse or focal slowing). In some cases a CSF pleocytosis is found after an attack of complex migraine. Prognosis is good. Preventive treatment is necessary if the attacks are severe and if they cannot be relieved by rest or sleep. Symptomatic headaches may be produced by a variety of causes. Rarely, it is secondary to increased intracranial pressure. In the great majority of cases recurrent headache is due to migraine. Usually, clinical data are sufficient for diagnosis, though in some cases the diagnosis is difficult and it is necessary to perform laboratory examinations in order to exclude symptomatic headache.