Overview, Diagnosis and Symptoms
Migraine is common among children and adolescents, with up to 82% of adolescents reporting having a migraine before the age of 15, while about 6% experience migraine yearly. Pediatric migraines are as disabling as adult migraines, though they may be shorter in duration. Diagnosis in this population can be difficult since the symptoms may vary significantly over the course of childhood. As a result, the diagnostic criteria from the International Classification of Headache Disorders often lack the flexibility required to make an accurate diagnosis of migraine in the pediatric population.
The key diagnostic criteria for childhood migraine are:
- Shorter duration than adults that can sometimes be as short as just one hour, although the overall duration is 1-72 hours.
- There is often bifrontal or bitemporal, rather than unilateral pain
- Pediatric patients often have difficulty describing the severity of their migraine pain. Asking them to draw a picture or using a face scale or numerical scale can be very helpful in determining their pain levels.
- Children often have trouble expressing their symptoms, which may need to be inferred from their behavior. For example, photophobia, phonophobia or the presence of nausea aggravated by physical activity often needs to be determined by the parent or caretaker from behavioral cues.
- Other associated symptoms may include difficulty thinking, fatigue and lightheadedness.
Childhood Periodic Syndromes and Other Migraine Variants
Childhood periodic syndromes are variants of migraine that occur in childhood. They include cyclical vomiting, abdominal migraine and benign positional vertigo of childhood. The headache may be mild or absent with these syndromes and may occur at a very young age; vertigo may begin in toddlers while episodes of cyclical vomiting and abdominal pain may start in young children. These syndromes may persist in various forms into adulthood, although they often resolve and are replaced by more typical symptoms of adult migraine.
A major concern is making an accurate diagnosis of these childhood periodic syndromes, which is based on a thorough understanding of the associated differential diagnosis. The differential diagnosis includes neoplasm, metabolic disorders, and gastrointestinal disorders; referral to a child neurologist, neurologist, or headache specialist who is familiar with childhood headache may be necessary.
Aura symptoms often start in childhood and adolescence, specifically basilar-type migraine and familial hemiplegic migraine. Basilar type migraine may present with vertigo, tinnitus, diplopia, ataxia, altered consciousness, bilateral parasthesias, dysarthria, impaired hearing, and altered visual symptoms in both temporal and nasal fields, but no motor weakness is present. The aura symptoms typically resolve within 60 minutes. A secondary cause of headache must be excluded.
Fully reversible motor weakness is a key component of familial hemiplegic migraine. There may be visual, sensory or dysphasic aura symptoms as well. Often, there is a first or second-degree relative that has a similar history. It is imperative to consider a secondary cause and do a thorough evaluation of these patients.
Status migrainosus lasting greater than 72 hours is rare in children, but warrants evaluation and intervention should it occur.
‘Red Flags’ in the Diagnosis of Childhood Migraine
A secondary cause of migraine should be considered in the following circumstances:
- Escalating frequency and/or severity of headaches over several weeks (under four months) in a child under the ages of 12 or 7
- A change of frequency and severity of headache patterns in young children
- Fever is not associated with migraine at any age, especially in children.
- Headaches accompanied by seizures
- Altered sensorium may occur in certain forms of migraine, but is not the norm and requires attention to determine an appropriate assessment and intervention.
Parents and caretakers are often most concerned about a brain tumor or other malicious neurological disorder. It is important to reassure both the child and parent of the proper diagnosis, and discuss the normal progression of migraine from childhood through adolescence and into adulthood.
Interested in learning more about Migraine research? Please call 561-845-0500. The Premiere Research Institute in West Palm Beach regularly conducts clinical research studies in the field of Migraines. To find out more about these studies click here or sign up for our newsletter to keep informed about the newest treatments, articles, and research that are being conducted in the field of Migraines.