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  • Updated 08.21.2023
  • Released 07.11.1994
  • Expires For CME 08.21.2026

Migraine in childhood



Childhood migraine is common, affecting 9% to 10% of children. Migraine in children commonly causes bilateral or midfrontal headaches. The peak incidence of migraine in males of all ages is 10 to 14 years, and for females, it is 20 to 24 years. Parents’ biggest concerns regarding the etiology of childhood headaches are brain tumors or vascular problems, particularly aneurysms. However, these concerns are usually unwarranted when the examination is normal and the headaches are episodic. The CHAMP trial has led some clinicians to question the utility of pharmacological treatment for migraine. However, many pharmacological approaches are still warranted. Newer medications include antagonists to calcitonin-gene-related peptides. The benefits of a healthy lifestyle and nonpharmacologic treatments to prevent acute migraine and to forestall chronic migraine are increasingly recognized. Neuromodulation devices will likely be used more in the future. The author reviews the clinical manifestations and discusses treatment strategies.

Key points

• Headache duration may be as short as 1 hour.

• Many children and teenagers have migraine headaches. However, the lack of normality between attacks should raise concern about the accuracy of the diagnosis.

• Neuroimaging is usually not necessary.

• No migraine aura lasts more than 60 minutes.

• Medications are helpful, particularly acutely, but lifestyle changes and nonpharmacologic methods 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 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. During this time, it was also 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 (28). 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 between migraine and epilepsy. In the early 20th century, Moebius coined the term “status migrainosus,” which was similar to the term for the prolonged epileptic state (28).

Even though Tissot, Calmeil, and Liveing mentioned patients whose migraine started during childhood (09), the onset of migraine in early childhood (between the ages of 1 and 4 years) was not well described until the early 20th century (65). 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 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 (09).

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