Pediatrics in Review
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 Vol. 28 No. 2, February 2007
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Right arrow Neurologic Disorders

(Pediatrics in Review. 2007;28:43-53.)
© 2007 American Academy of Pediatrics

Pediatric Migraine


Donald W. Lewis, MD*
 * Professor of Pediatrics and Neurology, Children’s Hospital of the King’s Daughters, Eastern Virginia Medical School, Norfolk, Va

The first 300 words of the full text of this article appear below.


   Learning Objectives
 
After completing this article, readers should be able to:

  1. Recognize the diagnostic criteria for pediatric migraine.
  2. Describe the clinical spectrum of migraine in children and adolescents.
  3. Discuss the acute and preventive treatments of migraine.


   Introduction
 
Headache is a common chief complaint in pediatric offices and may be a symptom of a host of illnesses from viral infection to intracranial neoplasm to migraine. The clinical spectrum of migraine represents a significant subset of headache, occurring typically as recurrent, episodic attacks of head pain plus a variety of accompanying symptoms, separated by symptom-free intervals. Its most common form, migraine without aura, is characterized as intense frontal or temporal headache lasting from 1 to 48 hours, accompanied by autonomic symptoms such as nausea, vomiting, and sensitivity to light and sound. Occasionally, migraine with aura in children is accompanied by dramatic neurologic signs and symptoms such as hemiparesis, language or mental status disturbances, visual disorders, or oculomotor dysfunction. This review provides an update on the current understanding of the evaluation, classification, pathophysiology, diagnostic criteria, and management of the migraine spectrum in children.


   Evaluation
 
The evaluation of a child who has recurrent headaches begins, and in most cases ends, with a thorough medical history and complete physical and neurologic examinations. Clues to the presence of secondary causes of headache such as tumors, infection, intoxication, or hydrocephalus are uncovered through this systematic process, as is the delineation of primary headache syndromes.

The first step is taking a history. Twelve key questions that can aid in distinguishing migraine from other primary headaches (ie, tension-type or cluster) or secondary causes of headache include:

  1. What is the time pattern of your headache: sudden first headache, episodes of headache, everyday headache, gradually worsening, or a mixture?
  2. How and when did your headache begin?
  3. How often does the headache occur, and how long . . . [Full Text of this Article]






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