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Prognosis of headache in children: a 25-year follow-up
Carlota Ferreirinha Rodrigues Lopes1,2, Tiago Proença Dos Santos3, Isabel Pavão Martins4
1Pediatrics Department, Central Alentejo Hospital Centre, Alentejo, Portugal. carlotalopes@campus.ul.pt.
Insights
Most childhood migraine patients continue to experience headaches into adulthood, though many report improvement. Male sex was the only predictor of a favorable outcome in this long-term study of pediatric migraine.
Area of Science:
- Neurology
- Pediatric Neurology
- Epidemiology
Background:
- Childhood migraine is a common neurological disorder with uncertain long-term outcomes.
- Understanding the natural history and prognosis of pediatric migraine is crucial for effective management.
- Predictors of favorable outcomes in childhood migraine require further investigation.
Purpose of the Study:
- To describe the natural history of childhood migraines.
- To evaluate the long-term prognosis of pediatric migraine patients.
- To identify predictors of a favorable outcome in individuals diagnosed with migraine in childhood.
Main Methods:
- A cohort of 118 children (ages 2-15) diagnosed with migraine in 1994 were re-evaluated 25 years later.
- A standardized telephone interview assessed headache characteristics, treatment, precipitants, and family history.
- Follow-up diagnosis was confirmed using ID-Migraine and a semistructured interview.
Main Results:
- 88 patients (75%) were re-evaluated, with 43 having migraine at follow-up (average age 41.2).
- Over 25.5 years, 33% experienced remission, 41% maintained their diagnosis, and 26% evolved into different headache types.
- 66% reported improvement, with male sex being the sole predictor of a favorable outcome.
Conclusions:
- The majority of pediatric headache patients (66%) continue to experience headaches into adulthood, often with reported improvement.
- Boys showed a higher tendency towards remission compared to girls.
- Age, genetics, and hormonal factors likely influence the phenotypic expression of migraine.
Aim:
To describe the natural history, evaluate the long-term prognosis, and identify predictors of a favorable outcome of childhood migraines in a cohort of children who had been diagnosed with migraine 25 years before.
Methods:
One hundred eighteen children with headache (ages 2 to 15), observed in a headache outpatient clinic of a University Hospital in 1994, by one of the authors, were revaluated in 2019/2020 by a standardized telephone interview specifying headache characteristics, treatment, precipitants, and family history. Headache diagnosis at follow-up was based on ID-Migraine and confirmed by a semistructured interview.
Results:
Revaluation was achieved for 88 (75%) patients (43 with migraine), 47 women and age average 41.2 ± 3.2. Over the follow-up (average 25.5 years), 33% of the patients had experienced remission, 41% maintained the same diagnosis, and 26% evolved into a different headache. Sixty six percent reported an improvement. Only eight patients were attending regular consultations because of headache. Male sex came out as the only predictor of a favorable outcome.
Conclusion:
Most patients (66%) with pediatric headache continue to experience headache although reporting a significant improvement. Boys tended to remit more often than girls. This data suggests that age, genetics, and hormonal factors may play an important role in migraine phenotypic expression.
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