This article includes discussion of migraine in childhood, childhood migraine and juvenile migraine. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.
Childhood migraine is common, affecting 4% of children. Migraine in children commonly causes bilateral or midfrontal headaches. The peak incidence for migraine in males of all ages is 10 to 14 years, and for females, it is 20 to 24 years. The biggest concerns parents have regarding the etiology of childhood headaches are brain tumors or vascular problems, particularly aneurysms. However, when the exam is normal and the headaches are episodic, these concerns are usually unwarranted. The CHAMP trial has led some clinicians to question the utility of pharmacological treatment for migraine. However, many pharmacological approaches are still warranted. In addition, alternative treatments, including acupuncture, biofeedback, and nutraceuticals, have not been adequately studied to show efficacy. The benefit of a healthy lifestyle to treat acute migraine and to forestall chronic migraine is increasingly recognized. For chronic migraine, one treatment to be considered is injection of the greater occipital nerve. The author reviews the clinical manifestations and discusses treatment strategies.
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• Headache duration may be as short as 1 hour.
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• Many children and teenagers have migraine headaches. However, lack of normality between attacks should raise concern about the accuracy of the diagnosis.
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• Neuroimaging is usually not necessary.
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• No migraine aura lasts more than 60 minutes.
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• Lifestyle changes are important treatment modalities.
Historical note and terminology
Although headache with fever was mentioned in Sumerian and other ancient literatures, these references were probably to malaria rather than to migraine. The first reliable description of migraine was probably given by Aretaios of Kappadokia in the first century A.D., when he described "heterocrania." In the second century A.D., Galen used the word "hemicrania," from which the word "migraine" derives, as a synonym for "heterocrania." In Medieval Europe, Hildegard von Bingen suggested that migraine was often unilateral because the pain was so severe that it could not be tolerated if it were on both sides of the head. During the Renaissance, explanations for unilaterality included the separation by the falx cerebri. In addition, during this time it was postulated that migraine was caused by yellow bile, and furthermore that the vapors proposed by the Galenic theorists could ascend (as from the stomach to the brain). In this theory, anatomic connections were not necessary (21). The first unmistakable descriptions of migraine with aura were from the 17th century and included the observations of Charles Le Pois, who described premonitory symptoms of his own migraine. Since then, many other investigators have described their own auras. In the 19th century, Liveing and Gowers contributed to the knowledge of the relationship of migraine with epilepsy. In the early 20th century, Moebius coined the term "status migrainosus," which was similar to the term for the prolonged epileptic state (21).
Even though Tissot, Calmeil, and Liveing mentioned patients whose migraine started during childhood (07), the onset of migraine in early childhood (between the ages of 1 and 4 years) was not well described until the early 20th century (57). Edward Flatau's book, La Migraine, published in 1912, was the most comprehensive review to that time. Among the therapies he reviewed, ergotamine is the primary medication that is still used. In 1926 Maier reported a successful clinical trial of ergotamine in migraine. The work of H G Wolff, Headache and Other Head Pain, published in 1948, is considered a classic, and was a forerunner to much of the successful migraine research of the 20th century. Traditionally, many doubted that migraine was much of a problem in childhood, but the important epidemiological studies of Bille established the high prevalence of childhood migraine (07).