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Published on: June 2, 2014
Extended Phenotyping of Migraine in Children: A Cross-Sectional Study in a Specialist Children's Headache Clinic
Nazia Karsan1, Prab Prabhakar2, Peter J Goadsby3
1Headache Group, NIHR King's Clinical Research Facility and SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Neurology, Children's Headache Clinic, Great Ormond Street Hospital for Children, London, UK.
Insights
Pediatric migraine patients often experience more premonitory symptoms (PS) as their condition becomes chronic. Cranial autonomic symptoms (CAS) and allodynia in children may indicate central sensitization.
Area of Science:
- Neurology
- Pediatric Medicine
- Headache Disorders
Background:
- Pediatric migraine presents differently than adult migraine, posing diagnostic challenges.
- Understanding the extended phenotype in children is crucial for accurate diagnosis and management.
- This study aimed to characterize the unique features of migraine in pediatric patients.
Purpose of the Study:
- To systematically investigate and describe the extended phenotype of pediatric migraine.
- To identify specific symptoms and their prevalence in children with migraine.
- To explore correlations between disease duration and symptom presentation.
Main Methods:
- A cross-sectional study of 105 new pediatric migraine patients.
- Data collected via detailed symptom questionnaires at the initial clinical visit.
- Statistical analyses included descriptive statistics, Cohen kappa, Spearman correlation, and logistic regression.
Main Results:
- The study included 65% female patients aged 5-17 years, with a mean disease duration of 4.7 years.
- 93% reported premonitory symptoms (PS), 58% experienced cranial autonomic symptoms (CAS), and 23% had premonitory CAS.
- Vertigo (53%) and allodynia (16%) were present; disease chronicity correlated with increased PS, and CAS predicted allodynia.
Conclusions:
- Pediatric migraine is characterized by an enriched premonitory symptom phenotype that increases with disease chronicity.
- Cranial autonomic symptoms and allodynia in children may signify central sensitization.
- These symptoms might share neurobiological mechanisms independent of peripheral nociceptor activation.
Background:
The pediatric migraine phenotype may exhibit differences to adults, leading to diagnostic challenges. We aimed to perform a cross-sectional systematic study to characterize the extended phenotype of pediatric migraine.
Methods:
New migraine patients presenting to the Children's Headache Clinic were included (n = 105). Data were collected via a detailed symptom questionnaire at the first clinical encounter and were analyzed using descriptive statistics, Cohen kappa (k), Spearman correlation (ρ), and Poisson and binomial logistic regression models within SPSS.
Results:
Patients were 65% female and aged five to 17 years (median 14, interquartile range [IQR] 11 to 15), with a mean disease duration of 4.7 years (S.D. 2.8). Monthly headache frequency was 1 to 30 days (median 30, IQR 12 to 30). Attack duration varied between 2 and 168 hours (median 12, IQR 5 to 72). The majority (81%) experienced bilateral headache. Premonitory symptoms (PS) were reported by 93% (range 0 to 7; mood change and tiredness most commonly), cranial autonomic symptoms (CAS) by 58% (range 0 to 6; pallor and lacrimation most commonly), and premonitory CAS by 23%. Vertigo (53%) and allodynia (16%) were present. The laterality of headache and CAS showed agreement (k = 0.5, P < 0.001). For every year of disease duration, 1.07 times more PS were reported (95% confidence interval [CI] 1.03 to 1.12, P < 0.001). The number of CAS (odds ratio 2.13, 95% CI 1.2 to 3.8, P = 0.01) significantly predicted allodynia.
Conclusions:
Children display a more enriched PS phenotype with disease chronicity. CAS and allodynia may be markers of central sensitization with shared neurobiological mechanisms in the absence of peripheral nociceptor activation.
