Migraine in Children and Adolescents
Shlomo Shinnar MD, PhD1
Bernard D'Souza MD2
1 Resident and Fellow in Neurology, Division of Pediatric Neurology, Johns Hopkins University School of Medicine, Baltimore
2 Assistant Professor, Neurology and Pediatrics, Division of Pediatric Neurology, Johns Hopkins University School of Medicine, Baltimore
Migraine is a genetic disease with wide clinical expression and is a fairly frequent cause of headache in children and adults. This poorly understood disorder is characterized by paroxysmal attacks of vasoconstriction and vasodilation. The vasoconstrictive phase is responsible for the aura and the neurologic deficits when present, whereas the vasodilatory phase is associated with the headache.
The headaches are classically unilateral and throbbing and are associated with nausea and vomiting. A prodromal phase is found in classic migraine. Attacks may occur as frequently as twice a week or as rarely as once a year. They are often precipitated by stress, fatigue, exertion, illness, or other trigger factors, with stress being the most common. Attacks may last from 30 minutes to a day and are often terminated by vomiting and then sleep. Attacks in children tend to be briefer than in adults and have more pronounced autonomic features. Establishing a proper diagnosis is important as specific, effective therapeutic modalities are now available for migraine. This review will summarize the different migraine syndromes and present an approach to the management of the child with migraine.
INCIDENCE AND EPIDEMIOLOGY
Migraine was once thought to be relatively rare in children, but it occurs in all age groups and is a common form of childhood headache.
