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Short-duration migraine without aura in children: a retrospective cohort study of attack duration and prognosis
Jiajun Ma1, Zhiwei Yu1, Xin Li1
1Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents' Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China.
Background:
Migraine without aura (MwoA) is the most common migraine subtype in children and can cause persistent impairment of quality of life. The International Classification of Headache Disorders, 3rd edition (ICHD-3), requires an attack duration of ≥2 h to diagnose pediatric MwoA; however, this threshold is debated, and several studies suggest that a lower limit may be appropriate in children.
Methods:
In this single-center retrospective study, children with primary headache seen in our neurology clinic from 2018 to 2023 were identified. Baseline demographic and headache characteristics were extracted from records. Patients were grouped by typical attack duration into a short-duration MwoA group (SdMwoA, ≥1 min to <2 h) and an MwoA group. Headache outcomes at 6 months, 12 months and at the last follow-up were collected via clinic visits or structured telephone interviews. Multivariable logistic regression was used to identify factors associated with headache-free status and any improvement at 6 and 12 months.
Results:
Of the 293 screened children, 192 (97 SdMwoA patients and 95 MwoA patients) met the inclusion criteria; follow-up data were available for 67 (69.1%) and 66 (69.5%) patients, respectively. Compared with the SdMwoA group, the MwoA group more often had a headache history ≥1 month before presentation (61.1% vs. 41.2%, p = 0.006) and prior preventive treatment (29.5% vs. 12.4%, p = 0.004), while the other baseline features were similar. At the last follow-up, headaches had remitted or improved in 57/67 (85.1%) SdMwoA patients and 54/66 (81.8%) MwoA patients (p = 0.613). Typical attack duration was not associated with outcomes according to multivariate regression modeling.
Conclusion:
SdMwoA and MwoA have comparable short- to mid-term outcomes. These findings support a more flexible, child-centered interpretation of the ICHD-3 duration criterion in pediatric migraine, indicating that typical migraine phenotypes with attacks less than 2 h warrant consideration of MwoA when alternative diagnoses have been excluded.
Insights
Pediatric migraine without aura (MwoA) attacks shorter than 2 hours show similar outcomes to longer attacks. These findings suggest a flexible approach to diagnosing childhood MwoA based on clinical presentation.
Area of Science:
- Pediatric Neurology
- Headache Medicine
Background:
- Migraine without aura (MwoA) is a common pediatric headache disorder.
- Current diagnostic criteria (ICHD-3) for pediatric MwoA require attack duration of ≥2 hours, a threshold debated for children.
- Shorter attack durations may be appropriate for diagnosing MwoA in pediatric populations.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of pediatric MwoA with shorter attack durations.
- To compare outcomes between children with short-duration MwoA (SdMwoA, <2 hours) and those meeting the standard MwoA criteria (≥2 hours).
- To evaluate the appropriateness of the ICHD-3 duration criterion in pediatric migraine diagnosis.
Main Methods:
- Retrospective single-center study of children with primary headaches (2018-2023).
- Patients categorized into SdMwoA (≥1 min to <2 hours) and MwoA (≥2 hours) groups.
- Demographic and headache data collected; outcomes assessed at 6, 12 months, and last follow-up via clinic visits or phone interviews.
- Multivariable logistic regression used to identify factors associated with headache outcomes.
Main Results:
- 192 children included (97 SdMwoA, 95 MwoA); follow-up data available for 69%.
- MwoA group had longer headache history and prior preventive treatment compared to SdMwoA group.
- Headache remission or improvement observed in 85.1% of SdMwoA and 81.8% of MwoA patients at last follow-up (p=0.613).
- Attack duration was not significantly associated with headache outcomes.
Conclusions:
- Short-duration MwoA and MwoA exhibit comparable short- to mid-term outcomes in children.
- Findings support a more flexible, child-centered interpretation of the ICHD-3 duration criterion for pediatric migraine.
- Migraine phenotypes with attacks <2 hours warrant consideration for MwoA diagnosis after excluding other conditions.
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